What are the supportive care measures for hidradenitis in the groin area?

Supportive Care for Hidradenitis Suppurativa in the Groin

All patients with hidradenitis suppurativa in the groin require three essential supportive measures: pain management, appropriate dressings for draining lesions, and patient education materials. 1

Core Supportive Care Measures

Pain Management

• Treat pain actively with NSAIDs or other analgesics as needed for symptomatic relief, as pain is a critical outcome measure in HS management. 1, 2
• Consider intralesional triamcinolone 10 mg/mL for acutely inflamed lesions, which significantly reduces pain, erythema, edema, and suppuration. 1, 3, 2

Wound Care and Drainage Management

• Provide dressings for all pus-producing lesions, with selection based on drainage amount, anatomical location, and patient preference. 1, 2
• Apply warm compresses to affected areas for symptomatic relief. 2
• Use antiseptic washes (chlorhexidine, benzoyl peroxide, or zinc pyrithione) to reduce bacterial load and control malodor, though no specific data exist comparing agents. 1, 3, 2

Patient Education

• Provide written patient information materials to all patients at diagnosis. 1

Lifestyle Modifications

Weight Management

• Refer patients to weight-management services when relevant, as obesity has an odds ratio of 33 for HS and prevalence exceeds 75% in HS patients. 1, 2, 4

Smoking Cessation

• Refer patients to smoking-cessation services when applicable, as smoking has an odds ratio of 36 for HS. 1, 2, 4

Clothing and Friction Reduction

• While evidence is limited to patient surveys, recommend loose-fitting cotton clothing to minimize friction in the groin area, as 16% of patients report worsening from tight clothing/friction. 1

Comorbidity Screening (Critical for Quality of Life)

Screen all patients for the following conditions at baseline: 1, 2, 4

• Depression and anxiety (highly prevalent in HS patients)
• Cardiovascular risk factors: diabetes, hypertension, hyperlipidemia, and central obesity
• Inflammatory bowel disease if persistent gastrointestinal symptoms are present
• Metabolic syndrome components

Disease Severity Assessment

• Document Hurley stage at baseline for the worst-affected region to guide treatment decisions. 1
• For Hurley stage III (severe) disease, consider immediate referral to dermatology secondary care. 1
• Measure treatment response using pain scores, quality of life instruments, and inflammatory lesion counts. 1, 2

Long-term Monitoring for Complications

In patients with long-standing, moderate-to-severe HS, monitor for: 1

• Fistulating gastrointestinal disease
• Inflammatory arthritis
• Genital lymphoedema (particularly relevant for groin involvement)
• Cutaneous squamous cell carcinoma
• Anemia

Critical Pitfalls to Avoid

• Never perform simple incision and drainage as definitive treatment – recurrence rates approach 100%, though it may provide acute relief when other methods are not feasible. 1, 2
• Avoid recommending specific deodorants or antiperspirants – weak evidence shows no clear link between these products and HS, despite patient anecdotes. 1
• Do not rely on dietary supplements (zinc, vitamin D) as primary supportive care – insufficient evidence supports routine supplementation despite some retrospective data. 1

Multidisciplinary Approach

• Manage patients via a multidisciplinary team approach, particularly when considering surgical interventions for groin disease. 1