From the Guidelines
Chlorhexidine wash is a recommended topical treatment for hidradenitis suppurativa, as it can help reduce bacterial load and decrease inflammation and infection risk. According to the North American clinical management guidelines for hidradenitis suppurativa, published in the Journal of the American Academy of Dermatology in 2019 1, topical therapies, including chlorhexidine, are part of the medical management approach for this condition. The guidelines provide a therapeutic algorithm informed by the available evidence at the time of the review.
For mild to moderate hidradenitis suppurativa, using a 4% chlorhexidine gluconate wash once daily in affected areas during showering can be beneficial. It is essential to apply the wash to affected areas, leave it on for about 1-2 minutes, and then rinse thoroughly. However, it is crucial to avoid using chlorhexidine on open wounds or near the eyes, ears, or mouth. Chlorhexidine works by disrupting bacterial cell membranes and reducing the surface bacteria that can worsen hidradenitis suppurativa flares.
The use of chlorhexidine as part of a comprehensive treatment approach is supported by the increasing evidence regarding topical and systemic medical treatment of hidradenitis suppurativa, as noted in the capsule summary of the guidelines 1. While chlorhexidine can help manage symptoms, it is essential to remember that it does not address the underlying immune dysfunction and follicular occlusion that cause hidradenitis suppurativa. Therefore, it should be used in conjunction with other measures, such as warm compresses, proper wound care, avoiding tight clothing, weight management, smoking cessation, and medical treatments prescribed by a healthcare provider, for optimal outcomes.
Key points to consider when using chlorhexidine wash for hidradenitis suppurativa include:
- Using a 4% chlorhexidine gluconate wash once daily in affected areas
- Avoiding use on open wounds or near sensitive areas
- Leaving the wash on for 1-2 minutes before rinsing
- Using chlorhexidine as part of a comprehensive treatment approach
- Combining chlorhexidine with other measures, such as warm compresses and proper wound care, for optimal outcomes.
From the Research
Effectiveness of Chlorhexidine Wash for Hidradenitis Suppurativa
- There is limited direct evidence on the effectiveness of chlorhexidine wash for hidradenitis suppurativa (HS) in the provided studies 2, 3, 4, 5, 6.
- However, chlorhexidine has been shown to be effective in reducing colonization and infection with antimicrobial-resistant bacteria in intensive care units 5.
- A study on the pharmacology and clinical applications of chlorhexidine found that it is a widely used and effective skin antisepsis preparation, especially when combined with alcohol 6.
- While there is no direct evidence on the use of chlorhexidine wash for HS, its antimicrobial properties suggest that it may be beneficial in reducing bacterial load and preventing infections in HS patients.
- Further research is needed to determine the effectiveness of chlorhexidine wash as a treatment for HS.
Current Treatments for Hidradenitis Suppurativa
- Current treatments for HS include drug therapy, combined drug and surgical therapy, or surgery alone, depending on the stage of the disease 2.
- Systemic therapies, such as adalimumab and infliximab, have been shown to be effective in improving quality of life and reducing symptoms of HS 4.
- Topical and systemic retinoids have also been used in the management of HS, although their effectiveness varies 3.
- Lifestyle modifications and surgical approaches may also be used to manage HS, particularly in moderate to severe cases.