Surgical Management of Hidradenitis Suppurativa: An Insight

Introduction

Hair follicles and sweat glands are affected by the chronic inflammatory skin condition of hidradenitis suppurativa. This illness, also known as acne inversa, typically starts with the emergence of lumps on the skin that resemble pimples. These bumps may become more painful if left untreated, penetrate deeper into the skin, and develop pus-filled pockets (boils). Frequently, the pockets rip open. Often, there is the development of definite large scars after they heal.

Where Does Hidradenitis Suppurativa Affect?

Typically, hidradenitis suppurativa affects body parts where skin meets skin. These regions could be the

• Inner thigh.

• Groin (genitals and the area around the anus).

• Buttocks.

• Breasts.

• Underarms.

Who Does Hidradenitis Suppurativa Affect?

• The prevalence of hidradenitis suppurativa in the United States ranges from one percent to four percent.

• Males experience it less frequently than females do.

• From puberty (about 11 years old) until about age 40, hidradenitis suppurativa is frequently seen in young people.

• People who are dark, overweight or obese, and smokers are more commonly affected.

How Is Diagnosis of Hidradenitis Suppurativa Made?

• A dermatologist (a medical professional specializing in skin conditions) will thoroughly examine the skin.

• The doctor will inquire if there has ever been a history of skin issues.

• Examines general health to rule out any systemic illness.

• Examine the skin's look in great detail.

• Take note of where the bumps are present.

• Doctors will inquire about the bumps' duration and whether they occur and disappear frequently.

• Confirming a diagnosis of hidradenitis suppurativa may involve blood tests. To rule out other skin disorders, doctors might also conduct a biopsy (removing a part of the skin as a sample for testing) if pus is present.

How Is Treatment for Hidradenitis Suppurativa Done?

Even though there is no treatment for hidradenitis suppurativa, early recognition and diagnosis can help stop the condition from worsening and leaving new scars. Different people experience different symptoms, which come and go. Many other therapies are available, and the following treatments are typically combined. The choice of treatment is based on how severe the hidradenitis suppurativa is.

Non-Surgical Approach:

Non-surgical approach can be used for mild to moderate conditions.

Initial treatments for minor ailments may entail using natural solutions like:

• Spend ten minutes daily in a warm bath or using warm compresses on the affected area.

• To decrease or destroy bacteria, use topical cleansing products such as antibacterial soaps, disinfectants, and acne washes.

• Utilize anti-inflammatory drugs such as Celecoxib, Ibuprofen, and Naproxen.

• To avoid garments rubbing against the skin, dress loosely.

• Always keep weight at a healthy level. The skin in the affected areas is more irritated by friction when carrying extra weight.

Treatment options for painful skin lesions (moderate illness) include:

• Prednisone and other corticosteroids are used to treat inflammation and discomfort.

• Anti-inflammatories like Celecoxib, Ibuprofen, and Naproxen.

• Antibiotics such as Erythromycin, Amoxicillin or Clavulanate potassium, Tetracycline, and Minocycline. Additionally, Erythromycin-based topical creams are occasionally recommended. These are employed to treat lesions that are infected.

• The Food and Drug Administration (FDA) authorized the first biologic drug to treat mild to severe hidradenitis suppurativa, Adalimumab, a tumor necrosis factor-alpha inhibitor.

• Other treatments that can be tested include birth control pills and retinoids (drugs that combat acne and address hormonal reasons).

Surgical Treatment:

Laser Treatment: Usually, under the skin, hair follicles, hair grows from a root. The follicle in hidradenitis suppurativa clogs up with oil and dead skin cells. It is unclear why this occurs, but it might be related to DNA, hormones, or immune system issues. The skin's bacteria gorge themselves on the trapped dead cells and oil. These bacteria produce the usual swelling, pus, and smells as they grow. During the laser treatment, intense light is directed to the roots of the hair follicles during laser hair removal. The heat from the sunlight destroys the hair follicles and prevents further hair growth. The condition's symptoms appear to improve when doctors utilize laser hair removal. One benefit of laser therapy is that, unlike medication, it does not have systemic adverse effects. Additionally, laser therapy typically results in less discomfort and scarring than surgery.

Deroofing: Deroofing, also known as unroofing, is a simple, quick, and affordable process. It works well in mild to severe hidradenitis suppurativa and is simple for surgeons to execute. It can be done under local anesthetic at a doctor's office. The roof (upper surface) of a lesion (sore) and associated sinus tracts are surgically removed with this tissue-saving treatment. Scraped off is the material covering the bare floor. After that, the lesion is left unbandaged to heal naturally. Once the scar heals, there is no restriction of movement.

Surgical Incision and Drainage: A precise incision and drainage are utilized when a person with hidradenitis suppurativa seeks care in the emergency room because of pain and suffering. It entails cutting the lesion or abscess and removing the pus inside. When other procedures are impractical, the procedure provides alleviation. Incision and drainage are not advised unless necessary for emergency relief. When lesions are removed in this manner, nearly all of them recur in an average of around three months.

Excision as Part of Therapy: Another typical surgical treatment used to treat the condition is resection (cutting out) of lesions. Doctors may employ one of two excision techniques based on the area and the severity of the lesions.

Localized, Limited Excision: For mild to severe hidradenitis suppurativa that is well-defined, constrained, and single lesions, local excision is appropriate. Under local anesthetic, this operation can be done as an outpatient procedure. After local excision, one study indicated that roughly 40 percent of lesions recurred. This is a far better result than incision and drainage as therapy.

Broad Excision: Radical excision, also known as extensive local excision, is frequently done in severe hidradenitis suppurativa. It entails eliminating the following:

• Lesions.

• Supporting tissue.

• Sinus arteries.

• Surrounding skin covered in hair.

To ensure no diseased tissue is left behind, wide margins (areas) are excised surrounding the lesions. Early in hidradenitis suppurativa, some clinicians advise wide excision to stop the disease from progressing.

The extensive surgical incision left behind by wide excision is repaired using skin grafting and flap procedures in plastic surgery. Although these techniques can hasten the healing process, lesions might recur more frequently than if the wounds were left untreated and covered with a bandage.

What Are the Complications of Hidradenitis Suppurativa?

• Throughout a patient's lifespan, hidradenitis suppurativa cycles with phases of outbreaks and healing.

• In rare instances, the illness worsens and leads to deep-lying abscesses (infection regions containing pus).

• The skin in that area may thicken due to ongoing healing and scarring; in difficult situations, the scarring may render the affected area stiff and challenging to move.

• Fistulas may develop inside the body due to ongoing healing and scarring. Fistulas are uncomfortable hollow passageways that need to be surgically repaired.

Conclusion

Hidradenitis suppurativa is a condition that can be treated in various ways. Surgical options vary greatly depending on the affected locations. Choosing the correct surgical procedure for the diseased area is crucial to prevent contractures, recurrences, and undesirable cosmetic outcomes.