Hidradenitis suppurativa wounds heal slowly because the underlying inflammation keeps disrupting normal skin repair. Whether you’re dealing with a draining abscess, a tunnel that opened on its own, or a surgical site left open after a procedure, the core principles are the same: keep the wound clean, manage drainage, control pain, and protect the surrounding skin. Healing timelines vary widely, from 8 weeks for smaller wounds to 16 months for large surgical sites left to close on their own.
Keeping HS Wounds Clean
Gentle daily cleansing is the foundation. An antiseptic wash, such as chlorhexidine or a benzoyl peroxide cleanser, helps reduce bacterial load on the skin surface. These are broadly supported by dermatology guidelines, though they carry a small risk of contact irritation if used too aggressively. Let the wash sit briefly, then rinse with lukewarm water. Avoid scrubbing open areas directly. Pat dry with a clean towel or gauze rather than rubbing.
Between cleanings, the goal is to maintain a moist wound environment. Wounds that dry out form hard crusts that slow new tissue growth and increase pain when dressings are changed. A thin layer of petroleum jelly or a medical-grade honey product on the wound bed before applying a dressing helps keep things moist without waterlogging the tissue.
Choosing the Right Dressing
Dressing selection depends almost entirely on how much your wound is draining. HS wounds are notorious for producing heavy exudate, especially during flares or in the weeks after surgery, so the dressing needs to absorb fluid without sticking to the wound bed.
For light to moderate drainage, simple foam dressings work well. They’re flexible, easy to cut to size, and pull away cleanly. For moderate to heavy drainage, alginate dressings (made from seaweed-derived fibers) or hydrofiber dressings offer higher absorption. You place these directly on the wound, then cover with a secondary pad. For the heaviest drainage, superabsorbent dressings with layered cotton, rayon, or cellulose cores handle the most fluid. Some people find that sanitary pads or even infant diapers, while unconventional, are practical and affordable options for managing large draining areas between formal dressing changes.
Silver-impregnated versions of these dressings add antimicrobial protection, which can help prevent secondary infection in open wounds. Silicone-backed dressings are particularly useful because they don’t stick to raw tissue, making removal far less painful. Cost is a real factor here. Advanced wound dressings add up quickly, and no single type has been proven superior for HS specifically, so finding an affordable option that manages your drainage level is a reasonable approach.
Controlling Odor
Wound odor is one of the most distressing parts of living with HS, and it’s worth addressing directly. Charcoal-containing dressings can absorb odor molecules before they escape. Silver dressings and metronidazole gel (a topical antibiotic) have the strongest evidence for reducing chronic wound odor, though neither has been studied specifically in HS. Using one of these in combination with frequent dressing changes, sometimes two or three times a day during heavy drainage, makes the biggest practical difference.
Managing Pain During Healing
HS wounds hurt, and the pain can be constant rather than just flaring with dressing changes. Topical options let you target the wound directly without the side effects of oral painkillers. A topical anti-inflammatory gel (diclofenac 1%) is the most commonly requested and easiest to obtain option. It provides steady, moderate relief and can be applied around the wound edges.
For sharper pain during dressing changes, a lidocaine cream (4% or 5%) applied 15 to 20 minutes beforehand numbs the area quickly. The downside is that the effect only lasts one to two hours. For longer-lasting relief, compounding pharmacies can prepare combination creams that blend several pain-relieving ingredients, extending the effective window so you only need to apply them two or three times daily. Capsaicin cream, sometimes suggested for other types of skin pain, is not effective for HS and tends to make things worse.
Topical Treatments That Reduce Flares
Beyond basic wound care, certain topical treatments can calm the inflammation that keeps HS wounds from closing. Topical clindamycin 1% gel, applied twice daily, is a standard first-line treatment for mild to moderate disease. It works as both an antibiotic and a mild anti-inflammatory on active nodules and draining lesions.
Resorcinol 15% cream is a less well-known but effective alternative. Applied once daily, it significantly reduces pain and shortens the duration of flares. In a study comparing the two, both produced meaningful improvement over 12 weeks when used on inflammatory nodules, abscesses, and tunnels. Resorcinol has the added advantage of being something you apply just once a day, which matters when you’re already juggling multiple dressing changes.
Nutritional Support for Skin Healing
Zinc plays a direct role in wound repair and immune regulation, and HS patients often have lower zinc levels. A pilot study of 22 patients with mild to moderate HS who had failed previous treatments (antibiotics, surgery, and other medications) found that supplementing with zinc gluconate at 90 mg per day produced a clinical response in every participant. Eight achieved complete remission and 14 had partial remission. Those who reached complete remission were able to taper down to a maintenance dose. The main side effects were gastrointestinal, mostly nausea, which is common with zinc supplements and can be reduced by taking them with food.
Post-Surgical Wound Healing
If you’ve had a deroofing procedure or wide excision, your surgeon may leave the wound open to heal from the bottom up rather than stitching it closed. This approach, called secondary intention healing, has lower recurrence rates for HS but takes significantly longer. Expect a timeline of 2 to 5 months for most wounds, though large or complex excisions can take up to 16 months to fully close.
During this period, the wound gradually fills in with new tissue (granulation) and then skin slowly grows inward from the edges. Keeping the wound moist and clean is critical throughout. Foam dressings are the standard for routine post-surgical care. For larger or more complex wounds that stall, negative-pressure wound therapy (a device that applies gentle suction through a sealed dressing) can speed up tissue growth and shorten the gap before a skin graft or further reconstruction. This is typically used for one to four weeks.
Some limited range of motion is normal while healing, especially for wounds in the armpits or groin. Gentle stretching and physical therapy help prevent permanent tightness as scar tissue forms.
Systemic Treatment and Wound Healing
Topical care and surgery address existing wounds, but controlling the underlying disease is what prevents new ones from forming. Biologic medications that target the inflammatory pathway can reduce the frequency and severity of flares. However, expectations should be realistic. In two large clinical trials published in the New England Journal of Medicine, improvement with biologic therapy was described as “relatively modest,” and complete resolution of symptoms was unlikely. These treatments are most effective as part of a broader strategy that includes wound care, lifestyle adjustments, and sometimes surgery.
Telling a Flare From an Infection
One of the trickiest parts of HS wound care is figuring out whether worsening symptoms mean a standard flare or a true secondary infection. Both can produce increased pain, redness, and drainage. HS flares can even cause fever, rapid heart rate, and elevated white blood cell counts, mimicking a serious infection. In a case series of six hospitalized HS patients who appeared septic, all met criteria for a systemic inflammatory response, yet blood cultures came back negative in every case. Their symptoms were driven by the disease’s own inflammation, not by bacteria in the bloodstream.
Signs that lean more toward infection include a sudden change in the smell or color of drainage (especially green or foul-smelling), rapidly expanding redness in the skin surrounding the wound, or new warmth and swelling in an area that had been stable. If you’re unsure, getting a wound culture can help clarify whether bacteria are colonizing (living on the surface, which is normal for open wounds) or actively infecting the tissue.