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Hidradenitis Suppurativa

The tubers can also move in the form of tunnels beneath the skin as they are exposed to the outside.

Hidradenitis suppurativa begins after puberty. It can continue for many years and may worsen over time. It can have serious effects on your daily life and emotional state. Early diagnosis and treatment helps manage symptoms; Prevents complications such as new tubers, scarring or depression.

Hidradenitis suppurativa commonly occurs around the hair follicles with the fat and sweat glands in the underarms, groin and anal regions. At the same time, it can be seen between the legs, breasts and thighs, where the skin rubs against each other. Hidradenitis suppurativa can affect a point or multiple areas of the body. 

Symptoms of Hidradenitis Suppurativa

Hidradenitis suppurativa can usually be seen as a single, painful lump that starts between puberty and age 40. For some people, the disease gets worse and affects many areas of the body. In some cases, only mild symptoms persist. Excessive weight, stress, hormonal changes, heat or moisture can aggravate the symptoms. In women, the severity of the disease may decrease after menopause. 

Causes of Hidradenitis Suppurativa

Hidradenitis suppurativa develops when hair follicles become blocked and inflamed. The exact cause of this blockage is not known. Possible causes include hormones, metabolic syndrome, genetic factors, irregular immune response, smoking and excessive weight.

Hydradenitis suppurativa is not caused by an infection. It's not sexually transmitted. It is not an infectious disease. 

Treatment Methods of Hidradenitis Suppurativa

There are different treatments for hydradenitis suppurativa. Early diagnosis and long-term treatment; It helps to control the pain, supports the healing of the wounds, prevents the formation of new tubers and can prevent complications.

Various treatment options are available. Once you have your doctor examination, you must decide together.

Pharmaceutical or Herbal Treatment:

Your doctor may prescribe one or more of the following types of medicine:

Topical and oral medications: These include medicines that contain antibiotics and vitamin A (retinoid).

Other drugs that reduce inflammation: Injecting steroids directly into the nodule can reduce inflammation. Oral steroids such as prednisone may also help. However, long-term use of prednisone has many side effects, including bone thinning (osteoporosis).

Hormones: Small studies comparing oral antibiotics with hormonal therapy have shown that hormone therapy is as effective as antibiotic in the treatment of hydradenitis suppurativa wounds. Hormonal therapy is not suitable for pregnant women due to the risk of side effects.

Medicine that suppress the immune system: Drugs infliximab (Remicade) and adalimumab (Humira) are promising in the treatment of hydradenitis suppurativa. These id biological inhibitors are TNF inhibitors. They work by neutralizing an immune system protein known as tumor necrosis factor. The researchers continue to evaluate these and similar drugs. Possible side effects include infection risk, heart failure and some types of cancer.

Painkiller medicine: If you still feel pain, your doctor may prescribe a stronger painkiller. For example; fentanyl patch, codeine, morphine, gabapentin and pregabalin.

Surgery (Surgical) and Other Procedures:

Hidradenitis suppurativa can be treated with various surgical procedures. The method used depends on the scope and location of the wounds as well as other factors.

Uncovering the tunnels: This procedure, known as digestion, is favored on the incision and drainage. Your doctor removes skin and subcutaneous tissue covering the tunnels connected to each other. This solution usually does not have to be repeated.

Fist debridement: This procedure is also called mini-unroofing and can be used to remove a single inflammatory nodule.

Incision and drainage: Surgical drainage can be an option when the disease affects a single small area. This treatment usually provides short-term pain relief, but the wounds tend to recur.

Tissue protective excision with electrosurgery: This can be an option for people with severe hidradenitis suppurativa. It combines skin-tissue excision with electrosurgical peeling (STEEP). The goal is to remove diseased tissue and maintain healthy tissue. General anesthesia is applied for the STEEP procedure.

Surgical removal: Surgical treatment of recurrent or severe symptoms involves removal of all involved skin. A skin patch may be needed to close the wound. Even after surgery, wounds may occur in other areas.

As a result, the removal of that region and the new tissue transplantation to that region is the most effective treatment today and is successfully applied. 

Risk factors

Factors that may increase your risk of developing the disease:

  • Age: Hidradenitis suppurativa is commonly seen in women between the ages of 20 and 29 years
  • Gender: Women are more prone to develop hydradenitis suppurativa than men.
  • Family history: The tendency to develop hidradenitis suppurativa may be hereditary.
  • Having other conditions: Hydradenitis suppurativa may be associated with many other conditions including arthritis, severe acne, obesity, inflammatory bowel disease, Crohn's disease, metabolic syndrome and diabetes.
  • Smoking: Smoking tobacco may cause hydradenitis suppurativa.  


Persistent and severe hydradenitis suppurativa often causes complications:

Infection: Infections may occur in the affected area. 

Wounds and skin changes: The wounds may heal, but leave rope-like scars, pitted skin, or darker skin spots than usual.

Restricted movement: Wounds and scar tissue can cause a limited or painful movement, especially when it affects the patient's underarms or thighs.

Clogged lymph drainage: There are many lymph nodes where hidradenitis suppurativa is seen. Scar tissue may interfere with the lymphatic drainage system, which may result in swelling of the arms, limbs or genitals.

Social isolation: location, drainage and smell of wounds; embarrassment, reluctance to communicate with people, may cause sadness or depression.

Cancer: Rarely, patients with enhanced hidradenitis suppurativa may develop squamous cell carcinoma of the affected skin.

Recommendations for the Treatment of Hidradenitis Suppurativa

Mild hydradenitis suppurativa can only be treated with self-care measures. Personal care is an important complement to any medical treatment. The following recommendations can help improve the speed of discomfort and wounds:

Do not disrupt your daily skin care: Gently wash your body with a nonsoap cleaner such as Cetaphil. Do not use your hands, pouches, fibers or other products that may irritate the skin. If a bad smell is present, try washing your body with antibacterial soap. The application of an additional absorbent powder or zinc oxide may also be helpful. Using antiperspirants can help keep the skin dry. Stop using any product that irritates your skin.

Manage your pain: Gently applying a wet or warm cloth can help reduce swelling and alleviate pain. Continue for approximately 10 minutes. Ask your doctor to recommend the most appropriate pain killer. And talk to your doctor about how to properly care for your wounds at home.

Avoid tight clothing and irritating products: Wear loose, light clothing to reduce friction. Some women prefer this method because they think that using tampons rather than hygienic pads creates less friction with the skin. Use detergents and other products that do not contain perfume, dye or enzymes.

Avoid injuring skin: For example, do not squeeze acne and wounds. Do not shave the affected skin.

Lose weight and stay active: not having healthy weight can make symptoms worse. Try to find activities that do not irritate your skin.

Consider changing your diet: Try to avoid dairy products, processed sugar, flour, beer and other foods containing yeast or wheat.

Avoid all tobacco products: Smoking and other tobacco use may lead to worsening of hydradenitis suppurativa.

Daily zinc supplements can help reduce inflammation and prevent new outbreaks. 


Is hidradenitis a genetic disease?

The exact cause of hidradenitis suppurativa is not known yet. However, genetic factors are one of the most important factors of this disease. In addition, hormones, excessive weight, alcohol and cigarette consumption are known to trigger hidradenitis supurativity. 

In which regions is the most common?

Hidradenitis suppurativa is frequently seen in the areas such as armpit, underarm, groin, belly button circumference, hips, inner legs and female genitals. 

Is there any non-surgical treatment of hidradenitis?

In the cases of early diagnosed hidradenitis suppurativa, progression of the disease can be prevented by drug treatment. However, the region's surgical removal is the most effective treatment. 

What are the characteristics of the hidradenitis wounds?

Hidradenitis suppurativa is characterized by small and flowing tubers that initially penetrate beneath the skin in the regions where it is seen. These chronic wounds can progress in the form of tunnels under the skin with time, and can also be seen in the surface of the skin as itching and itchy wounds. 

How many sessions are performed?

Hidradenitis suppurativa disease can be done in a single session by looking at the patient's condition and the size and depth of the wound, it can also take a few sessions. 

Is surgery a difficult operation?

As with any surgical operation, the degree of difficulty may increase or decrease depending on the person's body resistance, the size of the wound and the distribution area. Your doctor will share the most accurate information on this subject with your previous examinations. 

Is the surgery the exact solution?

Hidradenitis suppurativa begins after puberty. It can continue for many years and may worsen over time. The treatment of this disease with medications is not a definitive solution. Although it extinguishes for the moment, the time may also flare again. The definitive solution is surgery. If the surgery is well planned and taken broadly, it is not expected to be seen again in the received areas. 

How long is the duration of anesthesia done with the type of surgery?

Hidradenitis suppurativa usually takes 2-3 hours depending on the width of the wound site and the area under general anesthesia. 

Is hidradenitis a contagious disease?

Although HS is not an infectious disease, it can impair the quality of life of people living with this disease because it is intervined too late. 

When is the return to daily life after the operation?

After hidradenitis operations, it will be enough to stay in hospital for 1-2 days by looking at the condition of the person. One may start eating on the same day and making short walks. When the doctor foresees, the sutures are removed and the patient can return to his daily life at the end of a week. 

Is surgery a painful operation?

As in all surgical operations, the state of pain varies depending on the person's body. In addition, the width of the region to be operated, the areas to be interfered with also affect the pain status. However, the pain can be controlled in the hospital environment. Then you can easily overcome this period with your doctor's recommended painkillers. 

Is hidradenitis surgery a risky operation?

Each surgical operation carries a certain risk. These risks vary according to the technique, the general condition of the patient, the size of the disease, the size of the intervention and many other reasons. In addition to this, bleeding, infection, repetition of the region due to inability to be taken out well and the risks arising from anesthesia are present. 

What are the post-operative care?

As with any surgical operation after surgery, the recommendations of the doctor must be strictly adhered to in order to prevent the risks such as infection, bleeding and so on. In addition, very heavy exercises should be avoided during the first few weeks after the operation. 

Will there be very visible traces after surgery?

After all surgical operations, a trace remains due to the width of the surgical site. However, these traces lose considerable visibility over time. In Hidradenitis operations, there is a certain amount of trace in the regions where surgery is performed. 

What are the symptoms of hidradenitis suppurativa?

The most common symptom is the small pit areas with black spots. Except this; red, sensitive tubers, painful pea-sized tubers are symptoms of hidradenitis suppurativa. These are the growing and inflamed tubers that can last for many years under the skin. 

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