HS is a chronic, immune-mediated inflammatory condition that targets hair follicles in intertriginous areas, most commonly the axillae, groin, perineum, and inframammary regions. Its pathogenesis involves follicular occlusion, rupture, and a cascade of innate immune activation driven in large part by interleukin-17 and interleukin-23 signaling, producing the painful nodules, abscesses, and draining tunnels known as sinus tracts that define moderate-to-severe disease. Because these lesions recurrently open, drain, and heal only to flare again, many patients live with wounds that never fully resolve. The result is a skin disease that behaves, in functional terms, like a chronic wound disorder, demanding dressings, drainage management, infection surveillance, and frequent clinical attention, often for decades of a patient’s life.

That wound-care burden is precisely where the new survey focuses. The authors distributed their questionnaire with assistance from the HS Foundation, capturing the experiences of patients already connected to a specialty clinic, a population that, despite being relatively well served compared with many people living with HS, still reported meaningful friction in obtaining wound care. The study received ethical approval from the University of Connecticut Health Center Institutional Review Board and was conducted in accordance with the Declaration of Helsinki, with informed consent obtained from all participants. The datasets themselves are not publicly available due to patient privacy and institutional review board restrictions, but the published letter frames a set of concerns that align closely with what prior literature has documented about the structural barriers surrounding HS care.

Those barriers are not abstract. A 2023 qualitative study published in JAMA Dermatology by Barnes and colleagues documented patient perspectives of health system obstacles to accessing HS care, describing delays in diagnosis, fragmented referral pathways, and the exhausting effort required to navigate appointments across multiple specialties. A separate 2023 study by Poondru, Scott, and Riley in the International Journal of Women’s Dermatology examined wound care counseling from the dermatologists’ side, revealing that clinicians themselves often feel underprepared to guide patients through the practical realities of managing draining lesions at home. The new survey complements these works by centering the patient’s own perception of whether wound care is actually reachable, affordable, and coordinated, a question that has rarely been asked directly in this population.

The economic backdrop makes the findings more urgent. A 2019 retrospective analysis of US administrative claims data by Marvel and colleagues, published in BMJ Open, quantified the substantial disease burden and cost of HS, showing that patients accumulate high healthcare utilization across dermatology, surgery, and emergency settings. More pointedly, a 2023 single-center study by Towfighi and colleagues at an urban wound-care clinic documented the financial toxicity of HS, describing how the cumulative costs of dressings, clinic visits, and lost productivity weigh on patients who often already face socioeconomic disadvantage. HS disproportionately affects women, people of color, and lower-income populations, meaning that access gaps in wound care compound existing inequities rather than occurring at random.

Against this backdrop, the specialty clinic survey by Klufas, Ajmani, Strelzer, Zhou, and Sarfo serves as a targeted probe of a specific failure point. Wound care for HS is technically demanding: lesions may require absorbent dressings capable of handling continuous drainage, antimicrobial agents when secondary infection is suspected, and careful technique to avoid tissue trauma during dressing changes. Patients frequently perform these tasks themselves, without formal training, and the recent best-practice consensus published in the Journal of Wound Care by Swoboda and colleagues in 2025 represents the first comprehensive attempt to codify how HS lesions should be managed. Yet a guideline is only as effective as the access structures that deliver it, and the survey’s premise is that patients’ perceptions of access, whether they can get appointments, afford supplies, and find clinicians who understand HS-specific wound needs, are a measurable indicator of whether best practice ever reaches the bedside.

The study’s design reflects both the promise and the limits of survey-based research in rare and stigmatized diseases. By recruiting through a specialty clinic and partnering with a patient-focused foundation, the investigators reached individuals with confirmed diagnoses and lived experience of the care pathway, but the same recruitment strategy means the sample may underrepresent patients who have given up on the health system entirely, those without any dermatology connection, and those facing the most severe access barriers. The authors are transparent about these constraints, and the research letter format signals that the work is intended as an exploratory signal rather than a definitive prevalence estimate. Even so, perception data of this kind is valuable precisely because patient-reported access is a strong predictor of adherence, follow-up, and ultimately clinical outcomes in chronic disease management.

What emerges from the collective evidence is a picture of a disease whose wound-care needs fall into a gap between medical specialties. Dermatology clinics are expert in the systemic and biologic management of HS inflammation, with tumor necrosis factor, interleukin-17, and interleukin-23 inhibitors now standard options for moderate-to-severe disease, but they are often not structured to provide recurring wound care visits. Wound care clinics, meanwhile, are equipped for dressing management and debridement but may lack familiarity with HS’s distinctive disease course, in which wounds are not healing failures to be closed but active inflammatory lesions to be managed over time. Patients report shuttling between these systems, duplicating paperwork, repeating their histories, and sometimes paying out of pocket for supplies that no single provider has taken responsibility for. The survey’s contribution is to document, from the patient’s vantage point, how that fragmentation is experienced on the ground.

The implications for clinical practice are concrete. If patients perceive wound care as inaccessible, interventions should target the specific friction points: integrating wound care services into HS specialty clinics, training dermatology teams in HS-specific dressing selection and drainage management, standardizing insurance coverage for the supplies that HS wound care requires, and using patient foundations and telehealth to extend education to people who cannot reach specialty centers. The authors’ acknowledgment of the HS Foundation’s role in survey distribution hints at the kind of partnership model that could carry these improvements forward. Corresponding author Akua Sarfo of UConn Dermatology and her coauthors, who collectively designed the study, collected and analyzed the data, and wrote the manuscript without dedicated funding, frame the work as a call to measure and then dismantle the access barriers that patients themselves identify as most consequential.

For a disease that has historically been underdiagnosed, understudied, and shrouded in stigma, the accumulation of patient-centered evidence marks real progress. The 2025 wound care best-practice consensus, the dermatologist counseling survey, the qualitative health-systems study, and now this access-focused patient survey together form a scaffold on which health systems can build coordinated, equitable wound care for HS. The research letter does not offer a single dramatic finding, but it asks the right question in the right place: not whether wound care for HS is technically possible, but whether the people who need it can actually reach it. As biologic therapies continue to reduce inflammatory burden for many patients, the mechanical, financial, and logistical challenge of wound management will remain, and studies like this one ensure that the patients who live with that challenge daily are the ones defining what better access must look like.

Subject of Research: Patient perceptions of wound care access in hidradenitis suppurativa

Article Title: Perceptions of wound care access for hidradenitis suppurativa patients: a specialty clinic survey

Article References: Perceptions of wound care access for hidradenitis suppurativa patients: a specialty clinic survey. (n.d.). https://doi.org/10.1007/s00403-026-04924-w

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04924-w

Keywords: hidradenitis suppurativa, wound care, healthcare access, dermatology, patient survey, health disparities, chronic wounds, financial toxicity, specialty clinics, skin disease, wound management, patient-reported outcomes

Researchers led by Zheng Yang of the Emergency Department at Tongde Hospital of Zhejiang Province, affiliated with Zhejiang Chinese Medical University, analyzed 3,327 exposure-related clinic presentations recorded between October 2022 and October 2025. The team began with a larger pool of records and applied rigorous exclusion criteria, removing seven system-test entries, fifteen exposures classified as World Health Organization Category I, thirteen confirmed continuation visits, ten records with contradictory dates, and two unresolved duplicates. What remained was a clean hospital-based cohort suitable for examining two distinct questions: how quickly patients presented after a potential rabies exposure, and whether they had attempted any wound care on their own before arriving at the clinic.

The central finding concerns timing. Of the 3,327 presentations, 218, or 6.6 percent, occurred on a calendar day after the day of injury. Because the study relied on electronic medical records rather than precise timestamps, the researchers used a date-based operational proxy for delay: presenting on a subsequent calendar day rather than the same day. This is a conservative measure, and the authors are careful to frame it as such, but it captures a meaningful gap in access to care. Rabies virus travels along peripheral nerves at a relatively slow rate, and every hour of delay before prophylaxis begins extends the window during which the virus could, in principle, establish itself at the wound site and begin its ascent.

When the researchers fitted multivariable logistic regression models adjusting for other characteristics, patients aged 65 and older had significantly higher adjusted odds of subsequent-calendar-day presentation compared with the reference group aged 15 to 44 years. The adjusted odds ratio was 2.28, with a 95 percent confidence interval of 1.31 to 3.96 and a P value of 0.003. In practical terms, older adults in this cohort were more than twice as likely to show up at the clinic only after the calendar day of their exposure had passed. This age-related pattern persisted even after accounting for other variables in the model, suggesting that advancing age itself, or factors closely tied to it, creates a genuine barrier to prompt care-seeking after an animal bite or scratch.

The study also examined pre-hospital wound management, the self-directed cleaning or treatment that patients perform before reaching professional care. Guidelines from the World Health Organization emphasize immediate and thorough washing of bite wounds with soap and running water for at least fifteen minutes, a simple intervention that mechanically reduces viral load at the exposure site. The researchers modeled any pre-hospital wound self-treatment as a separate binary outcome. Interestingly, the estimate for the oldest age group pointed in the opposite direction: patients aged 65 and older appeared less likely to report any self-treatment, with an adjusted odds ratio of 0.71 and a confidence interval of 0.50 to 1.01. However, this estimate did not reach the conventional threshold of statistical significance, with a P value of 0.056, and the authors explicitly caution that it is imprecise and requires confirmation in future work.

A methodologically important point in the paper is that the two outcomes were modeled separately. The authors stress that their analysis does not establish a combined individual-level outcome linking delay and self-treatment within the same patient. In other words, the data cannot tell us whether an older adult who delays presentation is also the same person who skips wound washing, or whether these behaviors occur independently across the cohort. This distinction matters for intervention design: if delay and inadequate wound care cluster in the same individuals, targeted outreach could address both at once, whereas independent patterns might require broader, population-level messaging.

Two other associations emerged from the models. Patients who reported any pre-hospital wound self-treatment had higher adjusted odds of subsequent-calendar-day presentation, with an adjusted odds ratio of 2.72 and a 95 percent confidence interval of 2.00 to 3.69. One plausible interpretation is that people who attempt self-care may believe they have managed the problem adequately and therefore postpone professional evaluation, though the observational design of the study prevents any firm causal claim. The temporal pattern of the data also revealed that presentations during the clinic-opening calendar period of October through December 2022 were associated with subsequent-calendar-day presentation, with an adjusted odds ratio of 2.54. The authors interpret this finding as exploratory, noting that it may reflect the establishment phase of the clinic itself, shifts in case mix, seasonality of animal exposures, or unmeasured access factors rather than any stable behavioral pattern.

The implications for rabies control programs, particularly in China where dog-mediated rabies persists at low but nonzero levels, are significant. Older adults represent a vulnerable population on multiple fronts. They may have reduced mobility, limited awareness of modern PEP protocols, greater reliance on traditional remedies, or fewer social contacts who can urge them to seek care quickly. Sensory and cognitive changes can also affect how seriously a minor bite wound is perceived. Because the incubation period of rabies can range from weeks to months depending on the site and severity of exposure, a delay of even one day is unlikely to be decisive in every case, but the cumulative effect of late presentation across a population contributes to preventable deaths. Public health campaigns that specifically target older adults, perhaps through community health workers, primary care touchpoints, or family-centered messaging, could help close this gap.

The study’s design has limitations that the authors acknowledge. As a retrospective, single-center, hospital-based analysis, it captures only people who eventually reached the clinic, leaving unexamined the experiences of exposed individuals who never sought care at all. The date-based proxy for delay is coarser than exact time-to-presentation measurements, and self-reported wound treatment is subject to recall bias. The clinic-opening period association is explicitly flagged as potentially confounded by factors the data cannot disentangle. Nevertheless, the large cohort size, careful data cleaning, and transparent statistical reporting give the findings credibility, and the consistency of the age effect with prior studies cited in the paper’s supplementary comparisons, including work from Hangzhou and Wuhan, strengthens the case that delayed presentation among older adults is a reproducible phenomenon rather than a local artifact.

Funded by the Zhejiang Provincial Bureau of Disease Control and Prevention Science and Technology Program, the study received ethics approval from Tongde Hospital of Zhejiang Province and was conducted on de-identified electronic medical record data with a waiver of informed consent, in accordance with the 2013 Declaration of Helsinki. As rabies continues to kill an estimated tens of thousands of people worldwide each year, most of them in Asia and Africa, research of this kind translates a grim global statistic into actionable local insight. The message for clinicians and health communicators is clear: when it comes to rabies post-exposure prophylaxis, age is not just a demographic variable but a risk factor for the behaviors that allow a preventable disease to claim lives. Ensuring that older adults recognize exposures as emergencies, wash wounds immediately, and reach prophylaxis clinics without delay may prove one of the most cost-effective interventions available in the ongoing effort to eliminate rabies deaths.

Subject of Research: Age-related delays in seeking rabies post-exposure prophylaxis and pre-hospital wound care after animal exposures

Article Title: Age-related patterns in delayed presentation and pre-hospital wound management for rabies post-exposure prophylaxis: a retrospective hospital-based study in Hangzhou, China, 2022–2025

Article References: Yang, Z., Zhu, Y., Cao, K., Yi, X., Tian, S., Yan, B., & Zhao, Z. (2026). Age-related patterns in delayed presentation and pre-hospital wound management for rabies post-exposure prophylaxis: a retrospective hospital-based study in Hangzhou, China, 2022–2025. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14571-1

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14571-1

Keywords: rabies, post-exposure prophylaxis, older adults, wound management, delayed presentation, China, Hangzhou, retrospective study, public health, geriatrics, animal bites, BMC Infectious Diseases