Hidradenitis Suppurativa

Hidradenitis suppurativa is a progressive condition that often starts with an initial rash and is usually accompanied by painful breakouts and, eventually, a cluster of lesions with foul-smelling seepage. Surgical intervention may be the only way to relieve the painful symptoms when the condition is severe.

Is Hidradenitis Suppurativa Surgery right for you ?

Pre and Post Operative Instructions

The Hurley Criteria was designed to help people suffering from hidradenitis suppurativa determine the severity of their disorder:

Hurley’s Stage I: One or more affected areas form that are moderately separated from one another. There is no scarring or sinus tract formation at this stage. However, pus can begin to build up at the opened scar and travel deeper into the skin.

Hurley’s Stage II: At this stage, the affected areas continue to reappear. However, the breakouts are still separated from one another. A few scars and sinus tracts may be present at this point.

Hurley’s Stage III: The affected areas spread to form more extensive breakouts. Multiple scars and tracts are present.

Stage I can be managed effectively through appropriate medical treatment in most cases, which is why early detection is critical for controlling the disorder. By Stages II and III, the patient will likely require surgical intervention to keep the condition in check. During your initial consultation, your surgeon will provide a comprehensive exam and discuss your goals to understand if this procedure is correct for you.

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS) is a skin condition characterized by inflamed hair follicles or sweat glands, leading to pimples, boils, and an uncomfortable rash on the skin's surface layers. It can occur in anyone, but it doesn’t usually appear until after puberty and is more common in women. The disorder tends to affect areas where skin rubs together, like the underarms, groin, buttocks, and breasts. The recurrence of the lesions after initial healing may also result in a growing web of scarring in the affected tissue. The condition can significantly impact a person’s quality of life due to painful and noticeable symptoms.

Early signs of hidradenitis suppurativa include pimples like an acne breakout. In some cases, the breakouts clear up, only to reappear. Other people might have breakouts that continue. As the condition progresses, the breakouts become more severe and may include large boils that can rupture and emit a foul-smelling fluid. Scars become deeper and more prominent from the lesion, and tracks may form between the lesions under the skin. The breakouts can lead to infection and rarely, skin cancer may eventually develop in the area.


Before surgery

A patient care concierge will guide you through the entire consultation process, which can be attended in person or virtually. During the consultation, your surgeon will learn about your goals, answer any questions, and perform an examination to create a personalized surgical plan. You will then be matched with a surgical coordinator who will walk you through each step of the preoperative process.

Stop smoking
Fill prescriptions
Stop medications and supplements that exacerbate bleeding
Plan time away from work, childcare, and pet care for recovery
Find a family member or friend to bring you home and assist you after surgery

During the surgery

Different methods might be used to perform this surgery, depending on your specific symptoms and the severity of the condition:

Unroofing: Uncovers the tunnels by cutting away the skin that covers them. In many cases, this procedure needs only performed once to achieve its desired effect.

Drainage & Incision: Surgical drainage of the lesions for relief from discomfort. This technique can be used when the affected area is still relatively small, although positive effects may be temporary.

Cuts the lesions out of the skin and a surrounding layer of healthy skin to prevent a recurrence. A graft may be required to cover the area if a significant amount of skin is removed. It is possible for other breakouts to still occur in other areas. 

Regardless of the technique, a unique layered suturing method is used to minimize tension on the incision during the healing process, allowing for minimal scarring.

Surgery Duration
Local or General

After surgery

Recovery will vary, depending on the specific areas addressed and the amount of skin removed. Patients typically experience some soreness, swelling, and numbness in the area treated that subside within a couple of weeks. Your surgeon will provide detailed postoperative instructions and closely monitor your healing and recovery in the weeks and months following surgery. 

Even surgical treatment for hidradenitis suppurativa may not produce permanent results if the underlying condition is not properly managed. Since the symptoms can recur, additional treatment may be required to continue to manage the condition, including medications or lifestyle changes. You must continue working with your dermatologist to maintain your skin health.

Initial Recovery Period
Final Results