- read about hidradenitis suppuritiva
- see before and after photos-videos
- alternatives, risks, benefits & recovery
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 with boils. This is characterized by open wounds with draining pus from boils, 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 of the armpits 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 by one operation.
Video: Hidradenitis of the Armpits
Video: Hidradenitis of the Breasts
Read Dr. Stone’s blog about hidradenitis suppuritivaHidradenitis of the Armpits – Boils Under the Armpits
The only current available treatments are surgical excision with wound closure or Humira. Unfortunately most patients only get incision and drainage surgery rather than excision, which provides temporary relief but is not curative. Humira is an injected immune depressant that is approved for the treatment of arthritis, psoriasis, inflammatory bowel disease and hidradenitis. Unfortunately it is not a cure as it only keeps the disease under control while it is present in the body so it has to be taken for life. It is also associated with lymphoma and increased susceptibility to bacterial, fungal, viral and tuberculosis infections. If you have had herpes, shingles or tuberculosis or live in areas where fungal infections are common like central California you should not take Humira. Some patients cannot tolerate the medication.
The risks of humira treatment are life threatening infections or lymphoma. The risks of surgical excision are mostly associated with the means of wound closure. Skin grafts or flaps may not survive or may not survive completely and may heal with problematic scar tissue or require additional surgery. The most common problem associated with surgery is separation of the sutured incision lines as even the skin adjacent to hidradenitis affected skin is not normal so healing is delayed. The separated areas usually heal without additional surgery but this can take weeks to months.
The benefits of early treatment are quicker recovery from surgery and less risk of complications. The benefit of surgery is complete relief from painful, draining, smelly wounds.
The recovery is dependent on the surgery employed. For skin graft closure there is generally 2 weeks of immobilization of the treated area. For flaps there may or may not be immobilization. Regardless of the surgery most patients are back to their usually life in 2 to 3 weeks especially if treated early. Successful surgery is curative.
Dr. Aaron Stone
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Beverly Hills, Los Angeles,CA 90212