Hidradenitis suppurativa is an infection of the skin on the areas of the body where apocrine sweat glands exist. These areas are the armpits, groin, skin around the nipples and around the anus. The glands are a special type of sweat gland found only in these areas. Its sweat output is thicker containing more fat and is less watery than other sweat glands. In some individuals the output causes an increase in the number of bacteria on and in the skin leading to skin infections. This is characterized by open wounds with draining pus, red inflamed skin and pain. The infections subside with antibiotics and if severe usually return after stopping the antibiotics. After numerous bouts scar tissue and easily abraded skin can be found in affected areas. If left untreated severe cases can result in the infectious process invading underlying muscles necessitating their partial or complete removal.

Treatment in these severe cases or in recurrent cases is surgical removal of the affected areas to remove as much of the glands as possible as well as the scar tissue. The resulting open wound is then closed by skin grafts or preferably mobilized adjacent skin. The main goal is to remove the offending glands and maintain mobility leaving as little scar behind as possible. It is reconstructive surgery covered by health insurance and not cosmetic in nature. The same process is applied to pilonidal abscesses and cysts which are infectious processes of the skin near the tailbone from a different cause than hidradenitis. The pilonidal abscess or cyst is surgically removed and the resulting wound is closed with a flap of tissue. In the past this were cut and left to heal on their own which could take months. The current treatment of excision with flap closure makes the recovery time much shorter.

This patient had hidradenitis suppurativa with draining open wounds treated by removal of all armpit skin. Closure was achieved by moving skin in from the back. The after photo was taken 9 years after surgery and shows normal range of motion with complete cure of the problem.

Hidradenitis suppurativa surgery can effectively treat this disease. As each patient is an individual, different results can be expected in each patient.