Hidradenitis: when is surgery needed

Hidradenitis is a chronic, that is long-term, inflammatory skin disease. It starts in the hair follicles, most often in skin folds: in the armpits, groin, on the buttocks, around the anus and under the breasts. Painful lumps appear that can fill with pus and open, and over time tunnels and scars form under the skin.

The disease is not contagious and is not caused by poor hygiene. Its course differs from person to person: some people have occasional single lumps, while in others lesions cover larger areas and keep coming back. Smoking and excess body weight are linked to a more severe course.

On the buttocks and around the anus hidradenitis can resemble other conditions, such as an ordinary abscess, a pilonidal sinus above the tailbone or an anal fistula. These conditions are treated differently, so the doctor determines the difference by examination.

Hidradenitis is most often suspected when lesions keep coming back in the same skin folds, when there are several of them and when they leave scars and tunnels under the skin.

Treatment of hidradenitis often starts with a dermatologist. Depending on how severe the disease is, the dermatologist decides on medicines and skin care. Stopping smoking, losing weight if it is increased, wearing loose clothing made of natural materials and avoiding friction and shaving of the affected areas also help.

A single inflamed lump or abscess is sometimes opened and drained to relieve pain. This settles the current inflammation, but usually does not stop the lesion from coming back in the same place.

A surgeon considers surgery when lesions are persistent, keep coming back in the same place despite treatment, or when tunnels and scar tissue have formed under the skin. The aim of surgery is to remove the affected skin with the tunnels so that the disease settles in that area.

The decision is made after an examination, often in agreement with a dermatologist. The surgeon explains how much skin needs to be removed, how the wound will heal and what can realistically be expected.

The surgeon removes the affected skin and the tissue under it, including the tunnels. The extent of the procedure depends on the size of the affected area, so the general surgery price list of Maja Hospital has separate items for small, medium and large hidradenitis of the buttock or perianal area. The procedure is usually done under sedation with an anaesthetist. For other parts of the body, such as the armpit or groin, ask when booking.

After removal, depending on its size, the wound is sometimes closed with stitches and sometimes left to heal gradually with regular dressings. The surgeon decides how the wound is closed.

Recovery depends on the size of the procedure and how the wound heals. In general:

• dress and care for the wound as the surgeon advises and come to the scheduled check-ups,
• pain is eased with medicines prescribed by the doctor,
• after a procedure on the buttocks or around the anus, soft stools and careful hygiene after bowel movements help,
• avoid friction and pressure on the wound while it heals.

Hidradenitis is a long-term disease, so lesions sometimes appear in other places even after successful surgery. That is why it is a good idea to continue follow-up with a dermatologist. Contact the surgeon if you develop a fever, severe pain, bleeding or pus in the wound.