What is the best wash for hidradenitis suppurativa?

Best Antiseptic Washes for Hidradenitis Suppurativa

Chlorhexidine, benzoyl peroxide, and zinc pyrithione are the recommended antiseptic washes for hidradenitis suppurativa, with chlorhexidine having the strongest evidence base. 1, 2

Evidence-Based Recommendations for Antiseptic Washes

First-Line Options:

• Chlorhexidine: Supported by expert opinion and clinical guidelines as an effective antiseptic wash 1, 2
• Benzoyl Peroxide: Recommended especially when using topical antibiotics to reduce bacterial resistance 1, 2
• Zinc Pyrithione: Supported by expert opinion for its antimicrobial properties 1, 2

Additional Options:

• Bleach Baths: Can be considered as an alternative antiseptic option 1

Treatment Algorithm Based on Disease Severity

For All Patients (Regardless of Severity):

1. Daily antiseptic wash with chlorhexidine, benzoyl peroxide, or zinc pyrithione
2. Avoid triclosan-containing products (particularly in pregnant patients) 1

For Mild Disease (Hurley Stage I):

• Continue antiseptic washes
• Consider adding topical clindamycin 1% solution twice daily 1
• For acute flares: intralesional corticosteroid injections 1

For Moderate-to-Severe Disease (Hurley Stage II-III):

• Continue antiseptic washes alongside systemic treatments
• Add antiseptic washes to antibiotic regimens to decrease bacterial resistance 1, 2

Special Considerations

Pregnancy:

• Recommended: Chlorhexidine, bleach baths, zinc pyrithione 1
• Avoid: Triclosan (risk of endocrine-disrupting effects) 1

Pediatric Patients:

• Antiseptic washes can be used with an approach similar to adult populations 1
• Use alongside topical antibiotics to decrease bacterial resistance 1, 2

Important Clinical Pearls

• Pitfall to Avoid: Using antiseptic washes alone without addressing other aspects of HS management. Antiseptic washes should be part of a comprehensive treatment approach 2, 3

• Efficacy Monitoring: While antiseptic washes are recommended by expert consensus, there are limited data on specific agents. Monitor patient response and adjust accordingly 1

• Patient Education: Instruct patients on proper use of antiseptic washes as part of daily hygiene routine to maximize benefit 4

• Complementary Measures: Combine antiseptic washes with appropriate wound care based on drainage amount, location, and periwound skin condition 2

The choice of antiseptic wash should be integrated into the overall management plan for hidradenitis suppurativa, which includes medical therapy, potential surgical interventions, and lifestyle modifications such as smoking cessation and weight management 2, 5, 6.