Understanding the Zebras of Wound Care: An Overview of Atypical Wounds

Elizabeth Ansert, DPM, MBA, MA; Anthony Tickner, DPM, FACCWS, FAPWCA, FAPWH; Donald Cohen, DPM; Weldon Murry, DPM; Samuel Gorelik, DPM


Wounds. 2022;34(5):124-134. 

In This Article

Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic inflammatory disease that affects the hair follicles of apocrine sweat glands and is thought to be perpetuated by the microflora in the follicles[43,44] (Figure 7). Although this disease is associated with an array of comorbidities, such as metabolic syndrome, diabetes, atherosclerosis, irritable bowel syndrome, depression, and spondyloarthritis, the etiology is not well understood.[44] However, genetics and smoking are common factors in patients with this disease. The disease is usually clinically diagnosed and is characterized by inflammatory nodules, sinus tracts, abscesses, and fistulas. The most common areas affected are the perigenital and axillary areas. The wounds are typically painful and malodorous. Additional clinical information gleaned from skin biopsies, magnetic resonance imaging, and bacterial cultures can aid in diagnosis.

Figure 7.

Hidradenitis suppurativa (HS) in different Hurley stages. (A) Nodules, abscesses, and pustules on the gluteal areas in a male patient with Hurley stage 1 HS. (B) Abscesses, fistulas and scarring on the right axilla of a male patient with Hurley stage 2 HS. (C) Multiple abscesses, fistulas, nodules, and scarring involving the entire gluteal areas and the upper part of the thighs in a male patient with Hurley stage 2 HS. Used with permission; Oranges T, Janowska A, Chiricozzi A, Romanelli M, Dini V. HSTIME: a modified TIME concept in hidradenitis suppurativa topical management. Wounds. 2019;31(9):222–227.

Treatment is often multimodal. Patients are encouraged to make lifestyle changes regarding smoking status, weight loss, and exercise.[43,44] Pharmacologic anti-inflammatory therapy may be beneficial. Dressings often include an absorptive layer with a silicone adhesive. Topical antibiotics can be useful in the management of infection. Surgical intervention may be indicated if wounds are deep or infected, or if it would aid in closure. Surgical intervention with resection and/or flap closure is well tolerated, with complete recovery reported in 59.7% of patients in 1 study.[46] Promising but limited results have been achieved with molecular level intervention, such as TNF antibody therapy or therapies targeted at interleukin 17 and interleukin 1-alpha antibodies.[47]