Hydradenitis occurs when a plug of dead skin in the gland channel, emptying the hair follicle in areas of opposite skin surfaces, such as the armpits, under the breast and groin, initiates an infection process when bacteria multiply in the occluded gland, making the skin boil. The obstructive gland or boiling burst into the deeper layers of the skin; adjacent glands are involved; and abscesses. Subsequently, numerous mucous membranes or openings appear on the surface of the skin, and the entire hair area may be damaged. We call this process Hidradenitis Suppuritiva (HS).
As I described my first treatment choice for this process, it is the surgical removal of the implied skin and the closure of the resulting wound with the flap of the adjacent normal skin. However, this aggressive surgery is not always the best option for the immediate future due to insurance, financial, production or personal reasons. In the early stages of the disease, it is advisable to link the situation with the actual treatment and can provide significant relief.
Hurley the following diseases:
- Single or multiple abscess discharge without scarring or sinus. (A few small areas with a rare infection may be mistaken for acne.)
- Recurrent abscesses, single or multiple widely separated injuries, with the formation of the sinus tract. (Frequent extradition restricts movement and may require minor surgery such as incision and drainage).
- Diffuse or extensive participation in a regional area with several interconnected sinuses and abscesses. (Inflammation of areas the size of golf balls, and sometimes baseball, the development of scars, including the subcutaneous routes of infection.
We now know that there is an inflammatory process present in hydradenitis before there are any signs of infection, such as an abscess, and I call this preliminary stage I. At this stage, the skin is in contact with redness, soreness, heat and burning spots. before the appearance of an abscess. At this early stage, there is no runoff, and increased swaping can form a node that is very different from an abscess. Some doctors prefer antibiotics and injections of corticosteroids in the affected areas for the treatment of early stage 1 disease. Others give large doses of steroids by mouth or testosterone antagonists. Stage III is not amenable to these temporary measures due to the degree and depth of skin damage, but these measures may delay the progression of the disease when used in early phase I.
The stage of the disease and its appropriate treatment are complicated by the tendency of the disease to go through resting and active phases. A person suffering from HS uses a medicine, swallows a pill or somehow changes his diet at a time when the process is about to disappear, and then mistakenly attributes calm to the medicine, pill, etc. The treatments described here were energetically studied by numerous groups on a variety of wounds, including HS. Every day they work in residential and nursing homes throughout the country.
Local methods of treatment can be divided into types of dressings and drugs that are directly applied to the wound or soaked in a bandage.
Dressing is something like gauze that is applied directly to a wound to promote healing, stem bleeding, absorb a wound, remove dead tissue, prevent evaporation or falling off of drugs applied to the wound surface, and protect against or treat the infection. In the Middle Ages, they were mainly used so that others could not see the wounds. The historical belief that the wound should be kept dry in order to heal faster without infection was dispelled in the 1960s, when research showed that the wound surface cells died when they were allowed to dry, thereby prolonging the time needed for healing. Over the past 20-30 years, a huge number of different types of dressings with various properties or functions have been introduced.
TYPES OF DRESSES can be grouped as follows:
- LIMITING CLOTHES
made from algae algae and expanding as they turn from consistency in the form of gauze into the consistency of a gel when it absorbs drainage from a wound
- CONTACT WASHING DRESSES
made of low or non-adhesive material that allows discharge to pass through the material
- FLAT DRESSES
made of a material that absorbs drainage and actually sucks fluid from wounds
- HYDROCOLLOID DRESSES
prevent the wound from leaking and keep the wound surface moist, preventing external moisture from entering the wound. They look like thin pieces of flexible plastic that come in various thicknesses and shapes and stick directly to the skin around the wound. The most common brand is Duoderm.
- TRANSPORT DRESSES
are waterproof, keeping moisture and bacteria away from the wounded, keeping the wound moist and easily evaluated, as you can see through them. The most common brand is Tagaderm.
- MALE DRESSES
impregnated with sodium chloride. They remove the wound slightly, moistening the devitalized tissue, and are also used for moderate draining wounds, especially with tunneling or underlining.
After you choose a bandage, the next choice is whether to apply the medicine on the wound and under the bandage or impregnate the bandage. Dressings soaked in medicines from the manufacturer can be very expensive, in which case you can save considerable money by applying the medicine to clothes, rubbing it over the surface of the wound, and then sticking the dressing in place. Unfortunately, this is not possible with silver.
AVAILABLE MEDICATIONS include:
- HYDROGEL
They are mainly water in a gel base and are applied to dry wounds in order to keep them moist and prevent wounds from drying out.
- KLINDAMICINO OIL
In 1983, a double-blind study showed that local clindamycin-antibiotic is better than placebo, with a decrease in abscesses, inflammatory nodules and pustules of hydradenitis in the first month of treatment with a smaller difference between the two groups after 2 and 3 months of treatment. No side effects were reported, and treatment was simple for the administrator. Topical clindamycin is best suited to prepare patients for surgery, so after surgery there is less chance of complications.
- RESORCINOL
is an antiseptic and disinfectant that is an active ingredient in antifungal medications such as Clearasil. In a 2010 study, topical treatment with 15% resorcinol reduced pain from a painful nodule in all patients with hydradenitis suppurative. The drug should not be used in areas that have lost the integrity of the skin, because they can be absorbed into the blood circulation and cause a blood disease called methemoglobinemia (resorcinol poisoning). Drainage is a sign of loss of skin integrity and, therefore, eliminates the use of resorcinol.
--MEDIHONEY
Links and formulas for honey wound dressings can be found in the medical writings of ancient Egypt, Greece, Rome, India and China. Honey was used as a first-line treatment until the mid-1900s, when synthetic dressings and antiseptics were popular. Numerous studies dating back to 2004 show antimicrobial, anti-inflammatory and wound healing properties of honey improvement. Later studies have shown that adding wounded honey to topical antibiotics increases their effectiveness. This is not your usual culinary or table honey that you put on pancakes. Meduhins and manuka-honey - the main wound honey. They are bitter and not suitable for consumption as a food product.
DRESSES TREATED WITH MEDICATIONS
- Silver-drenched and honey-soaked alginate dressings
- Medihoney, unregulated alginate
CHOOSING DRESSES
Before using any of these drugs or dressings, you should be understood by your personal physician and have ongoing care, including the frequency of changes in dressing and baths controlled by them, to avoid sensitivity or allergic reactions that may occur immediately or after several uses well tolerated product. Even glue in a bandage or tape can be problematic. Obviously, if you are allergic to bee spots or medihoney honey, this is not a viable option.
If you are up to stage I resorcinol or medihoney under a transparent dressing is a good option, as they will reduce the infection, not allowing you to directly observe the zone of disease progression.
If you have stage I with visible abscess infections, but no drain clindamycin ointment and / or medihoney under a transparent dressing is a good option. It should treat the infection, allowing direct observation of this area. Ointment cannot be used for a long time, because you will have resistant bacteria.
After you begin to have drainage alginate or foam dressings, it is better to choose to absorb this drainage. Foam is better when the wounds have a depth for them, because the foam is thicker than alginate, which allows you to apply more padding with a smaller amount of dressing. Any of them can be obtained with silver or medihoney impregnated to fight the infection, at the same time as the drain is collected. They measure 6x6 cm. Impregnated forms are quite expensive, while medihoney tubes can be bought on Amazon for $ 15 per tube and applied to cheaper non-impregnated forms before use.
As the disease process subsides, you can switch to mesaltic dressings, and if there are open areas without drainage, then hydrocolloid dressings are very good options. It has been proven that hydrocolloid dressings applied to untreated areas after surgical initiation of hydradenitis minimize discomfort, speed up mobilization, stay dry longer and shorten the feeding time compared to regular gauze dressings. One of my patients had a wet spot on each buttock after the operation, the edges of which were glued together at bedtime and were torn when sitting or walking. Therefore, areas cannot heal. The use of Duoderm for each spot prevented them from getting up together at night, and they were cured.
SAVING DRESSES IN THE FIELD
Gluing dressings in place can be problematic if the drainage has an odor or large volume, as the frequent dressing changes, each time removing the tape, forms the skin around. These are two good options to keep the dressings in place.
- Tubular elastic mesh
You can create shorts from a tubular elastic material for sewing dressings on the groin or buttocks.
--Monthromy belts
The outer white parts of the Montgomery stripes stick to the skin on both sides of the wound, and the laces are strung between the holes to put on the wound. You untie and tie the laces to change the dressing in such a way that you do not need to leave the wrap off your skin. This is especially good for wounds that drain a lot of fluids. You can put alginate in there and hold it in place with the laces. Alginate will absorb the drain like a sponge. You can even change the dressing 3 or 4 times a day if you need.
You can make your own by using a 3-inch wide medical tape and folding the adhesive side onto yourself along one edge. Punch holes in a section of double tape thickness to cut through the threads, and you made your own Montgomery strap.
