If you have hidradenitis suppurativa (HS), you might have tried many treatments. These include medicines and changes in your lifestyle. But for serious cases, surgery is often the best choice to handle this tough skin problem.
Dr. Good Deed’s, a top expert in HS, will talk about the surgery options. They will cover the good and bad sides, and how to get better after surgery. This guide will help you choose the right treatment for your HS.
Thinking about surgery? You might be looking at incision and drainage, deroofing, or bigger excisions. Knowing about each method can make your choice easier. With your healthcare team’s help, you can find a treatment plan that fits your HS needs and improves your life.
What is Hidradenitis Suppurativa?
Hidradenitis suppurativa is a long-lasting, inflammatory skin condition. It often hits areas where skin rubs together, like the armpits, groin, and under the breasts. Many people confuse it with pimples or acne, which can delay getting the right diagnosis.
Symptoms, Causes, and Risk Factors
The main signs include painful, recurring boils or abscesses, sinus tracts, and scarring. The exact cause is still a mystery, but it’s thought to involve genetics, hormones, and environment. Risk factors like obesity, smoking, and family history can up the chances of getting it.
There’s no lab test for hidradenitis suppurativa. So, getting a proper diagnosis is all about clinical evaluation and care from dermatologists.
Doctors use many treatments, like antibiotics, steroid shots, and hormonal therapy. They also use biologics, retinoids, and pain meds. Sometimes, surgery is needed to manage the condition.
For mild cases, self-care helps a lot. This includes keeping skin clean, managing pain, losing weight, eating right, and quitting smoking.
Hidradenitis suppurativa can really mess with your mood and daily life. It can cause anxiety, shame, depression, and make everyday tasks hard. A team of doctors, including dermatologists and surgeons, might be needed for severe cases.
Diagnosis of Hidradenitis Suppurativa
Diagnosing hidradenitis suppurativa is tricky because it looks like acne or boils. Your doctor will look at your symptoms, medical history, and check the affected areas.
They might also do tests like a skin biopsy or use ultrasounds or MRI scans. Seeing a dermatologist who knows about hidradenitis suppurativa is a good idea.
Hidradenitis suppurativa affects about 1% to 4% of people, and women get it more often. It usually starts between puberty and 40, with most cases happening between 21 and 29.
There’s no clear link to race, but some groups might not be counted in studies. Early treatment and care that fits you are key to managing it.
Nonsurgical Treatment Options
Your doctor might suggest nonsurgical treatments first for hidradenitis suppurativa (HS). These include antibiotics, hormonal therapies, and biologic drugs. They also recommend lifestyle changes like losing weight, quitting smoking, and keeping your skin clean.
Medications and Lifestyle Changes
Topical antibiotics can be applied to the skin to fight infections near the surface. Oral antibiotics work better for deeper infections. Oral retinoids, made from vitamin A, target cell growth to treat symptoms not caused by infection.
Steroids can be injected into bumps to lessen pain and swelling. For severe cases, biologic drugs can block proteins that cause inflammation.
Changing your lifestyle is also key. Keeping a healthy weight and stopping smoking can help manage HS symptoms. Keeping the affected areas clean and avoiding irritation can prevent flare-ups and aid in healing.
Even with these treatments, some people with advanced or severe HS may need surgery. Surgery can offer long-term relief and improve their quality of life.
When is Surgery Recommended?
If you have moderate to severe hidradenitis suppurativa (HS), your doctor might suggest surgery. This is usually for those with Hurley Stage 2 or 3 HS. This means you have many abscesses, sinus tracts, and scars.
Also, surgery might be an option if other treatments didn’t work. Or if HS is really affecting your life. Your doctor will decide if surgery is right for you, based on how bad your condition is.
- Some signs you might need surgery include:
- Many abscesses, sinus tracts, and scars
- Scars on many parts of your body
- Not getting better with other treatments
- HS is really hurting your daily life
Talking to your dermatologist can help figure out if surgery is needed. It can help make your life better.
Incision and Drainage Procedure
Incision and drainage is a common surgery for HS lesions in early stages (Hurley Stage 1). It involves a small cut to drain fluid from an abscess. Then, the wound is packed with sterile gauze.
Risks, Benefits, and Recovery
This surgery can quickly ease pain and swelling. But, it often fails to keep symptoms away for long, with a nearly 100% recurrence rate. It’s seen as a short-term fix, not a lasting solution for HS.
Recovery from this surgery is quick, with pain relief in 2-3 weeks. Yet, the HS itself often comes back. More surgeries might be needed to handle the chronic nature of HS.
Incision and drainage doesn’t cure HS. It offers temporary relief but can’t stop the condition from flaring up again. Patients should talk to their doctor about a long-term plan. This might include deroofing or excision surgeries.
Deroofing Surgery for Hidradenitis Suppurativa
Deroofing is a surgery that helps with Hurley Stage 1 and 2 hidradenitis suppurativa (HS). It removes the top of a lesion but keeps the base. This method is better than others, with a 27% chance of the problem coming back. Most patients are very happy with this surgery, saying it’s worth it for others.
First, the doctor uses local anesthesia to numb the area. Then, they find the lesion’s outlet and clean it well. This helps fix the skin problems caused by HS.
The wound then heals on its own, which takes a few weeks. People can usually go back to their normal activities in 2 weeks. It takes about 4-5 weeks for the area to fully heal, with help from the doctor.
Even though it’s safe, there’s a 12.5% chance of problems like bleeding or infection. Also, HS can come back up to 25% of the time after surgery.
Still, deroofing surgery is a good choice for many, with quick recovery times and high satisfaction. Talking to a dermatologist can help decide if it’s right for you.
Excision Surgeries: Local and Wide Excision
If treatments like creams and antibiotics don’t work, surgery might be next. There are two main surgeries for hidradenitis suppurativa (HS): local and wide excision. Each has its own benefits and and results
Local Excision
Local excision removes just the abscesses or lesions. It’s for mild cases, Hurley Stage 1 HS. But, the problem often comes back in the same spot.
Wide Excision
Wide excision takes out a bigger area with many lesions. It’s for more serious cases, Hurley Stage 2 and 3 HS. Or for cases that keep coming back. The aim is to get rid of all the bad tissue to stop it from coming back and to lower cancer risk.
Research shows a low return rate of 13% after wide excision. It might control HS better than local excision. But, it’s a bigger surgery with a longer recovery.
Choosing between local and wide excision depends on your HS’s severity and your situation. Your doctor will help decide the best surgery for you. It’s often best to use surgery with other treatments like diet changes, medicine, and therapy for the best results.
Emerging Surgical Techniques
Traditional surgery has long been used to treat hidradenitis suppurativa (HS). Now, doctors are looking into new ways to help people with this chronic condition. Cryoinsufflation and laser treatment are two new methods showing promise.
Cryoinsufflation and Laser Treatment
It is a new method that uses liquid nitrogen to treat HS. It freezes the bad tissue, which might help symptoms last longer. Early studies look good, but more research is needed to know how it stacks up against other treatments.
Laser treatment is another new way to deal with HS. It uses strong lasers to remove the bad spots. This method can give patients relief for up to a year. But, it’s expensive and not always covered by insurance, making it hard for some to get.
These new methods, cryoinsufflation and laser treatment, could be big help for HS patients. They might be especially good for those with severe or hard-to-treat cases. As more research comes in, doctors can make these options even better. This could give more people ways to manage their HS symptoms.
hidradenitis suppurativa surgery
After surgery for hidradenitis suppurativa (HS), it’s key to take care of your wound. You might need to let the wound heal on its own or stitch it shut. Sometimes, skin grafts or flaps are needed for bigger wounds.
Recovery can take weeks to months. You’ll need to watch for drainage, pain, and infection. Hyperbaric oxygen therapy might help too. With good care and your doctor’s help, you can heal well and feel better.
Wound Care Considerations
- Keep the surgical site clean and dry to prevent infection
- Change dressings as directed by your healthcare provider
- Avoid submerging the wound in water until it has fully healed
- Monitor for any signs of infection, such as increased redness, swelling, or drainage
- Follow any specific wound care instructions provided by your surgeon
By following these steps and working with your healthcare team, you can recover well from your surgery. This way, you can see your symptoms lessen and enjoy a better life.
Potential Complications and Recurrence
Surgical treatments for hidradenitis suppurativa (HS) can help manage symptoms and improve life quality. But, there are risks and complications to think about. The chance of complications was 11.1%, and the chance of HS coming back was 16.2%. Possible issues include infection, nerve damage, and more.
Several things can affect the risk of problems and recurrence. For example, certain surgical methods and closure types can increase risks. Skin grafts, for instance, had a complication rate of 18.9%. The location of the surgery also matters, with multiple areas having a 16.0% complication rate.
HS often comes back after surgery, which is part of the disease’s chronic nature. The extent of surgery, how well the treatment works, and the disease’s severity all play a role. Patients with split-thickness skin grafts had a higher chance of recurrence. Also, having more lesions increased the risk of recurrence.
It’s important for patients to talk to their doctors about the risks and benefits of surgery. Understanding these can help patients make better choices and manage their expectations.
Conclusion
Hidradenitis suppurativa (HS) is a chronic skin condition that affects many people. It can make life harder. For those with more severe HS, surgery is often the best choice.
Surgery has different methods, each with its own benefits and risks. New treatments like cryoinsufflation and laser therapy are also being explored. Choosing surgery for HS should be a team effort with a healthcare expert.
The summary of hidradenitis suppurativa surgery options shows that surgery can work well for many. But, each person’s needs are different. It’s key to weigh the risks and benefits of each surgery.
The main aim in treating HS is to improve life quality. Working with a healthcare expert who knows HS well is crucial. This way, patients can find the best treatment for them, whether it’s surgery or not.