Understanding Treatments and Procedures for Managing Hidradenitis Suppurativa

Understanding Hidradenitis Suppurativa and Its Medical Procedures

Hidradenitis suppurativa (HS) is a long-term skin condition characterized by small, painful lumps under the skin. These lumps typically develop where the skin rubs together, such as the armpits, groin, under the breasts, and between the buttocks. Over time, these lumps can break open and smell. HS is not contagious or caused by poor hygiene.

HS occurs when the hair follicles get blocked and inflamed. It often runs in families and usually starts after puberty. Females are more likely to develop HS than males. Other risk factors include smoking, obesity, and mechanical friction to the skin.

There is no cure for HS, but various treatments can help manage symptoms. Treatment typically focuses on preventing new lesions from forming, managing pain and drainage, and removing damaged tissue to minimize scarring. Early diagnosis and treatment is key to preventing the condition from worsening.

Diagnosing Hidradenitis Suppurativa

Getting an accurate HS diagnosis involves a physical exam and discussion of medical history with a dermatologist. The doctor will look for characteristic signs and symptoms:

• Painful, pus-filled lumps under the skin
• Blackheads and scarring in common HS locations
• Tunnels under the skin from interconnected lesions
• Foul-smelling odor from drained lesions
• Ongoing symptoms for months or years

Other conditions like boils, herpes, and pilonidal cysts can mimic HS lesions, so its important to see a dermatology specialist. Diagnostic testing like cultures or biopsies may be done to rule out other causes. Be prepared to discuss any family history of HS and factors like weight, smoking, and friction that could impact your symptoms.

Early Treatment Options for Hidradenitis Suppurativa

Mild HS can often be managed with conservative at-home treatments, especially when started early. These options aim to prevent new lesions, reduce inflammation and pain, and keep the affected areas clean.

Warm Compresses

Applying warm, wet compresses to areas of swelling and pain can help promote drainage and healing. Do this several times a day for 15-20 minutes. Make sure to use clean washcloths each time.

Gentle Cleansing

Carefully wash lesions and affected areas with mild soap and water to remove dirt, bacteria, and drainage. Avoid harsh scrubbing. Pat dry gently. Antiseptic washes may also be recommended.

Over-the-Counter Pain Relievers

Pain relievers like acetaminophen or ibuprofen can help reduce swelling, tenderness, and discomfort caused by HS lesions.

Loose Clothing

Wear loose, breathable clothing that doesnt rub or chafe affected areas. Soft cotton underwear and shirts are ideal.

Weight Loss

If overweight, losing even a small amount of weight can ease friction and irritation from HS. Focus on cleaning up your diet and increasing activity.

Quit Smoking

Smoking makes HS worse. Quitting can significantly improve symptoms for many people.

Avoid Shaving Irritated Areas

Stop shaving over swollen or tender areas prone to HS lesions to prevent further irritation.

Medical Treatments for Hidradenitis Suppurativa

More advanced HS requires prescription medications, injections, and minor procedures to stop progression and manage symptoms. Your dermatologist will tailor treatment to the severity of your condition.

Oral and Topical Antibiotics

Antibiotics kill bacteria on the skin and reduce inflammation associated with HS. Oral antibiotics like tetracycline, minocycline, or clindamycin are commonly prescribed. Long-term antibiotic use often provides the best results.

Steroid Injections

Corticosteroid injections can temporarily shrink painful HS nodules and decrease inflammation. Triamcinolone is a steroid commonly used for HS. The effects are temporary so injections may be repeated.

Biologic Drugs

For moderate to severe HS, biologic drugs like adalimumab (Humira) can be highly effective. These drugs target the immune response that causes inflammation. Treatment is given by self-injection weekly or every two weeks.

Oral Retinoids

Retinoids like isotretinoin are derived from vitamin A and can help prevent HS lesions from forming. They may be prescribed alone or with other medications.

Anti-inflammatory Drugs

Drugs that reduce inflammation, like dapsone or metformin, may be used in conjunction with other HS treatments. This added inflammation relief can help prevent new lesions.

Hormonal Therapy

Since HS flares are often linked to menstrual cycles, hormonal treatments like oral contraceptives can help some women. These regulate hormones to prevent monthly hormone fluctuations.

Laser and Light Therapy

Treatment with laser, intense pulsed light (IPL), and blue light can reduce HS inflammation and lesions. Multiple sessions are usually needed for lasting results.

Surgery

When medication and other treatments no longer control HS, surgical removal of affected tissue may be an option. Common surgeries include:

• Excision to cut out lesions and scar tissue
• Deroofing to open and drain sinus tracts
• Laser therapy to vaporize affected tissue

Though surgery can be highly effective for severe HS, it does not offer a permanent cure. HS can still recur in operated areas. Multiple surgeries are often necessary over a lifetime.

Caring for HS Wounds After Medical Procedures

HS medical treatments like lancing, excision, and deroofing inevitably cause wounds. Caring for these properly during healing is vital to prevent infection and minimize scarring.

Keep the Incision Site Clean

Gently cleanse the affected area daily using mild soap and water or an antiseptic wash recommended by your doctor. Avoid rubbing or excessive pressure when cleansing. Make sure to pat dry thoroughly after washing.

Change Dressings Regularly

Wounds and incisions need to be kept covered with clean bandages or gauze. Change these dressings once or twice a day and anytime drainage soaks through. Contact your doctor if drainage smells foul or seems excessive.

Watch for Signs of Infection

Monitor the wound healing and watch for signs of infection like increased pain, redness, heat, swelling, foul odor, and pus. Fever can also indicate infection. Call your doctor right away if any of these occur.

Allow Gentle Air Circulation

Unless instructed otherwise, uncover healed incisions for 20-30 minutes a day to allow air circulation. This promotes drying. Avoid picking or scratching scabs.

Wear Loose Clothing

Clothing rubbing on wounds can disturb healing. Opt for loose, breathable clothing around affected areas.

Apply Antibiotic Ointment

Applying a thin layer of prescribed antibiotic ointment can prevent infection while also keeping the area moist. Common ointments include bacitracin, mupirocin, and polysporin.

Take Oral Antibiotics

Your doctor may prescribe oral antibiotics to prevent wound infections, especially if significant drainage, debris, or bacteria remained in the area before surgery. Take the full course as directed.

Use Prescribed Pain Medication

Over-the-counter analgesics and any prescribed narcotic pain medications can relieve normal post-procedure discomfort. Use only as directed and do not exceed dosage recommendations.

Apply Cool Compresses

Gently placing cool compresses over surgical sites can alleviate pain, swelling, and inflammation. Do this for 10-15 minutes a few times per day as needed for comfort.

Keep Incisions Dry

Cover incisions with waterproof bandages when bathing until fully closed and healed. Moisture can introduce bacteria and hinder healing.

Rest up

Your body needs extra rest for post-procedure healing. Take it easy and avoid strenuous activity. Follow any activity restrictions from your doctor.

Attend Follow-up Appointments

Its crucial to have your doctor examine the surgical site during follow-up visits to ensure proper healing. Report any concerns with the wound and discuss when normal activities can resume.

Caring for wounds after HS surgery or procedures takes some work, but is vital for minimizing pain, preventing infection, and optimizing healing. With proper incision care and follow-up, you can get back to normal life as quickly as possible.

Frequently Asked Questions About HS Medical Procedures

What procedures are used to treat hidradenitis suppurativa?

Common medical procedures for HS include incision and drainage, deroofing, excisions to remove lesions, laser and light therapies, and reconstructive plastic surgery. Less frequently used options include cryotherapy, electrocautery, and radiation.

How effective is surgery for hidradenitis suppurativa?

When medication is no longer effective, surgery can help control HS progression and manage symptoms. Excision to remove affected tissue offers the highest success rate. However, HS can still recur after surgery. Multiple procedures are often needed.

What is the recovery time after hidradenitis suppurativa surgery?

Recovery time depends on the extent of the procedure. Small excisions or deroofing procedures may take 1-2 weeks to heal. More extensive excisions with skin grafting can take 4-6 weeks for full recovery. Activity will need to be restricted until wounds heal.

How can I make hidradenitis suppurativa surgery scars less noticeable?

Proper wound care and minimizing trauma to the healing incision will help reduce scarring. Silicone-based gels and sheets can also improve the appearance of scars over time. In some cases, steroid injections or laser scar revision may help.

When should hidradenitis suppurativa wounds be packed?

HS wounds are sometimes packed with sterile gauze to promote drainage and healing from the inside out. Packing may be done after draining lesions or post-surgery. Your doctor will instruct you on proper techniques if packing is recommended.

What is the fastest way to heal after hidradenitis suppurativa surgery?

To help HS surgery wounds heal quickly, carefully follow your doctors postoperative instructions on cleansing, dressings, activity, and medications. Rest, proper nutrition, staying hydrated, and not smoking are also very beneficial.

Can laser hair removal help treat hidradenitis suppurativa?

Some studies suggest laser hair removal can reduce HS lesions, pain, and recurrence risk. It helps by destroying hair follicles where blockages and inflammation tend to start. Multiple treatments are required for long-term improvement.

Living with Hidradenitis Suppurativa

HS is a challenging condition, but the right treatments and self-care can make living with it easier. Work closely with your dermatologist to develop an effective medications regimen. Avoid skin irritants, friction, and anything that triggers flare ups. Treat wounds properly to prevent infection and scarring. Be patient, as finding the right treatment approach takes some trial and error. With time, most people find a maintenance plan that provides symptomatic relief and better quality of life.

Though HS has no cure, the array of available medical and surgical treatments can significantly improve this condition. Using these interventions alongside at-home care, wound management, and lifestyle changes provides the best chance at managing symptoms long-term. Working closely with your doctors allows customizing an approach for your situation and needs.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.