A bio-electric dressing improves post-deroofing outcomes in hidradenitis suppurativa by microbiome modulation: a split body, randomized clinical trial

<h2>Abstract</h2> Hidradenitis suppurativa (HS) tunnels represent treatment-resistant disease compartment that perpetuates inflammation, microbial dysbiosis, and relapse. Surgical deroofing remains the standard intervention, yet optimal post-operative wound management strategies are lacking. <h3>Objectives</h3> We aimed to evaluate the efficacy of a wireless bioelectric wound dressing (BEWD) compared to standard of care (SOC) in modulating tunnel-associated microbiota and preventing surgical site recurrence following HS deroofing. <h3>Methods</h3> In this randomized, single center, split-body trial, patients with bilateral Hurley stage II–III axillary disease underwent tunnel deroofing, with one side randomized to BEWD or SOC (petrolatum and gauze dressing). Subjects (n=12) were followed for 8 weeks to assess primary outcomes - healing rates. Secondary outcomes included disease recurrence at week 8, change in bacterial load, microbiome composition, and quality of life. <h3>Results</h3> BEWD-treated sites showed a significant reduction in bacterial load at weeks 2 and 4, post-excision with enrichment of commensals and a shift away from anaerobic taxa, not observed in SOC-treated sites. Minimal recurrences were observed on BEWD-treated sides alone compared to multiple recurrences on SOC- treated sites, with trends of improved healing trajectories. <h3>Conclusions</h3> Optimized wound care holds a potential to reduce surgical site recurrence and reverse HS dysbiosis. Our data emphasizes the importance of post-surgical care to improve outcomes in HS patients.