Although no hidradenitis suppurativa treatment can be considered a complete cure, surgery may provide longer-term relief to some.
Hidradenitis, also known as hidradenitis suppurativa, is a chronic skin disease that produces painful bumps under the skin. These pus-filled bumps occur in hair follicles near the sweat glands and in areas where skin frequently rubs against skin or clothing.
- There is no cure for this lifelong condition
- In severe cases, surgery may be appropriate for management of symptoms
Surgery for Hidradenitis Suppurativa
There are a few surgical options available for the treatment of hidradenitis suppurativa. Lancing of individual bumps is the simplest and least invasive surgical option, but it only provides short-term relief from painful flare-ups. Recurrence of bumps is likely following this treatment.
In many patients, bumps caused by hidradenitis suppurativa repeatedly appear in the same location. In such instances, a procedure called “unroofing” may be employed. It turns bumps and pockets under the skin into painless scar-tissue. This procedure is more resistant to relapse than lancing and draining.
Severe cases of hidradenitis suppurativa may require widespread removal of problem areas of the skin. During such procedures, the removed skin is replaced with skin from another part of the body in what is known as a skin graft. The new skin will attach and grow in the area just like the original skin.
Who is a Candidate for Surgical Treatment?
Hidradenitis suppurativa can become debilitating over time. Candidates for surgical solutions to hidradenitis suppurativa are those whose conditions are not well managed with other treatment methods. Patients with widespread flare-ups, intense pain over wide areas or who begin to experience difficulty with normal daily activities may benefit from surgical options.
What to Expect Before and After Surgery
Before surgical treatment of hidradenitis suppurativa can be performed, any existing infection or inflammation must be treated with medication. Anesthesia may be local or general, depending on the type of surgery. As with most surgeries, recovery involves wound care and watching for signs of infection.
Relapse is a common occurrence with hidradenitis suppurativa, even after a major surgical intervention has taken place. Lifestyle changes may help prevent recurrence of symptoms. Such changes should therefore be considered as part of post-operative care.
The most important change that patients can make is minimizing skin irritation from all sources. This includes avoiding injuries to the skin, keeping the skin dry and clean, and avoiding tight clothing that may rub against sensitive areas of the skin. Patients may need to stop shaving in problem areas to prevent irritation. Certain soaps or deodorants may irritate the skin and should be avoided. Excessive scrubbing in order to clean the skin may also be problematic. Gentle washing is recommended.
Maintaining a healthy weight may be beneficial in preventing flare-ups of hidradenitis suppurativa by reducing the surface area available for skin to rub against skin. If a patient is a smoker, quitting may ease symptoms. Keeping cool may also prevent outbreaks, which can be triggered by overheating and sweating.