Effects of dressings imbued with methylene blue and gentian violet in the treatment of chronic hidradenitis wounds

Background: Hidradenitis suppurativa (HS) is an inflammatory skin condition that causes open wounds in intertriginous areas. Common sites include the axillae, inguinal area, inframammary region, buttocks, and areas where the skin encounters friction. The severity and presentation of the wounds can vary, ranging from deep nodules to sinus tracts. These wounds caused by hidradenitis suppurativa tend to be painful, are associated with malodorous drainage, and are notoriously difficult to treat. They have substantial negative impact on patients’ quality of life, yet relatively few wound care options exist. The aim of this study was to assess the effectiveness of dressings imbued with methylene blue and gentian violet on subjects’ wound healing, pain, and quality of life.

Hypothesis: It is hypothesized that dressings imbued with methylene blue and gentian violet will promote wound healing and improve subjects’ dermatologic quality of life. 

Methods: 4 adult subjects with chronic wounds due to hidradenitis suppurativa were recruited from the Wake Forest Baptist Health Department of Dermatology HS clinic. 1 subject re-enrolled in the study with a new wound, for a total of 5 wounds studied. Subjects were instructed to dress their wounds with an ovine forestomach-based extracellular matrix covered by a polyurethane foam dressing imbued with gentian violet ( 0.00005 g/g) and methylene blue ( 0.00005 g/g). Wound were measured and photographed, and patients rated their pain (scaled 0-10) and dermatologic quality of life (via Dermatology Life Quality Index, DLQI). Wound measurements, photographs, and assessments were taken at the initial enrollment visit and again at weeks 1, 2, 4, and 8, after which the subjects’ participation concluded. 

Results: Between the initial study visit and week 8, average total wound surface area decreased 57.2 ± 36.3%, subjects’ pain ratings decreased on average 2.7 points, and average dermatologic quality of life improved 5 points. Additionally, patients generally reported improved odor control and comfort along with reduced pain and drainage. Granulation tissue increased in all subjects. 

Conclusions: All participants’ wounds decreased in surface area, though reduction in wound size varied greatly between participants. Most patients reported improvements in HS-related pain and dermatologic quality of life. Although small, our case series suggests that appropriate wound dressings, in addition to medical therapy, are an essential part of treatment for patients with chronic wounds due to HS. Breathable dressings imbued with methylene blue and gentian violet can help maintain a healthy wound bed and promote wound healing. 

Limitations: small study size may limit generalizability. HS-related pain ratings and the DLQI did not distinguish between wounds being treated in our study versus untreated wounds. 

Source of mentor’s funding or other support that funded this research: Wound dressings and research support were provided by Hydrofera.