If you have been diagnosed with hidradenitis suppurativa, you know all too well just how debilitating this chronic skin condition can be. While it typically does not appear on areas of the body that are visible day to day, it can become quite painful, even to the point of limiting your function. A progressive condition that often starts with an initial rash, it is usually accompanied by unsightly breakouts, and eventually a cluster of lesions with seepage that has a foul-smelling odor that can make you highly self-conscious and want to avoid people.

Early detection and treatment of hidradenitis suppurativa usually result in the most effective management of the disorder. When the condition is advanced, surgical intervention may be the only way to relieve the painful symptoms. Dr. Barrett offers surgical treatment for hidradenitis suppurativa at his Beverly Hills practice, helping patients with more severe forms of the condition.

What is Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS) is a painful and debilitating skin condition characterized by inflamed hair follicles or sweat glands, leading to the appearance of pimples, boils and an uncomfortable rash on the surface layers of the skin. The disorder often begins after puberty and 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, as some individuals avoid activities and people due to the painful and noticeable symptoms.

Early signs of hidradenitis suppurative include pimples like an acne breakout. In some cases, the breakouts clear up, only to reappear. Other people might have breakouts persist. 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 larger from the lesion and tracks may start to form between the lesions under the skin. The breakouts can lead to infection and rarely, skin cancer may eventually develop in the area.

Do You Need Hidradenitis Suppurativa Surgery?

Hidradenitis suppurativa can occur in anyone, but it doesn’t usually appear until after puberty. It can develop in both men and women although the incidence of women with the condition is higher. 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 begin to spread to form larger 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 Stage II and III, the patient will likely require surgical intervention to keep the condition in check. We recommend you schedule a consultation with Dr. Barrett as soon as possible to assess whether you are a good candidate for surgery.

Options in Hidradenitis Suppurativa Surgery

There are different methods Dr. Barrett might use for your hidradenitis suppurativa surgery, depending on your specific symptoms and the severity of the condition:

Unroofing – This process uncovers the tunnels by cutting away the skin that covers them. In many cases, this procedure only has to be performed once to achieve the desired effect.
Drainage and Incision – Dr. Barrett can use this technique when the affected area is still relatively small. Surgical drainage of the lesions offers relief from discomfort, although the positive effects may be only temporary.
Excision – This involves cutting the lesions out of the skin, as well as a surrounding layer of healthy skin to prevent a recurrence. If a significant amount of skin is removed, a skin graft may be required to cover the area. Even though the lesions are completely removed, other breakouts can eventually occur in other areas.

Procedure Overview

No matter which technique Dr. Barrett uses for your hidradenitis suppurativa surgery, it can be performed on an outpatient basis in his office. Most treatments can be performed using local anesthesia, reducing both risk and recovery time. Dr. Barrett’s meticulous suturing techniques ensure scarring after the procedure will be as minimal as possible.

After Hidradenitis Suppurativa 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. This might include a variety of medications as well as lifestyle changes. You will need to continue to work with your dermatologist to maintain your skin health.