What is hidradenitis suppurativa?
Hidradenitis suppurativa (purulent hidradenitis) is a chronic inflammatory skin disease that arises in areas rich in apocrine sweat glands and hair follicles. It is marked by painful, red nodules beneath the skin that turn into abscesses, burst and discharge pus, and over time form fistulous channels and scars. The disease most often appears in the armpits, groin, under the breasts, in the genital area and the perineum.
Although it is often mistakenly seen as an ordinary infection or the result of poor hygiene, hidradenitis is not a disease of uncleanliness. It is a chronic inflammation in which the hair follicles become blocked and inflamed, and then repeated purulent processes develop. A significant role in its onset is played by hereditary tendency, hormonal factors, smoking and excess body weight.
The disease progresses through stages: from single nodules and abscesses (early stage), through repeated foci with fistulas and scars, to an advanced form with branching fistulous channels and extensive scars covering a wider skin surface. The higher the stage, the greater the role of surgery in treatment.
Hidradenitis significantly affects quality of life — pain, pus, an unpleasant odor and scars interfere with movement, work and daily activities, and also carry a psychological burden. That is why it is important to recognize the disease in time and treat it comprehensively. At Medical Time we approach hidradenitis seriously and with understanding, choosing the procedure that suits the stage and needs of each patient.
When is surgical treatment indicated?
In the early phases hidradenitis is often treated with medication (local and systemic therapy), a change of habits and measures that reduce inflammation. However, with repeated and advanced changes surgery becomes key, because it removes inflamed foci and fistulous channels that medication cannot cure permanently. The decision is made by the surgeon after an examination.
Surgical treatment of hidradenitis is recommended in the following situations:
- a painful abscess that requires urgent drainage for relief
- nodules and abscesses that keep returning in the same place
- developed fistulous channels that constantly discharge and leak
- an advanced stage with extensive scars and affected skin
- changes that do not respond to medication and conservative therapy
- pronounced pain, an unpleasant odor and interference with daily activities
- the need for a lasting solution instead of the constant recurrence of foci
How hidradenitis surgery is performed
The type of surgical procedure depends on the stage of the disease and the extent of the affected skin. The goal is to remove the inflamed and fistulous tissue and thereby prevent recurrence in the same place. With limited changes the procedure is smaller, while advanced forms require a more extensive excision.
With an acute, painful abscess, incision and drainage is done first — a small incision through which the pus is released and the pain is relieved. This is an urgent measure that brings immediate relief, but by itself it does not resolve the disease permanently, because the focus can reappear.
For a lasting solution, excision is applied — surgical removal of the affected skin and subcutaneous tissue with the fistulous channels. With smaller changes a limited (local) excision is possible, while with advanced forms a wide excision of the entire affected area is done. Depending on the size of the wound, it is closed directly with sutures, left to heal gradually (secondary healing) or covered with a flap or skin graft.
Which technique is best is assessed by the surgeon individually, taking care to remove all the diseased tissue while keeping the function and appearance of the area as good as possible. The removed tissue is, as a rule, sent for histological analysis.
Preparation for surgery
Preparation depends on the extent of the planned procedure. Smaller interventions (drainage, limited excision) are done under local anesthesia, on an outpatient basis, while more extensive excisions require analgosedation or general anesthesia and appropriate preoperative preparation. Everything begins with an examination by the surgeon, who assesses the stage and plans the procedure.
If a procedure under sedation or general anesthesia is planned, standard preoperative preparation is carried out (laboratory tests, if needed an ECG and an anesthesiologist's examination), the rules on fasting apply and accompaniment for the return home is arranged.
What is important to inform the surgeon of before the procedure:
- all medications you take, especially blood thinners
- chronic illnesses (especially diabetes) and a tendency to impaired healing
- whether you smoke — smoking worsens hidradenitis and slows wound healing
- allergies to medications, anesthetics and dressing materials
- your treatment of hidradenitis so far and earlier interventions
- for more extensive procedures — the rules on fasting and arranged accompaniment
The procedure, anesthesia and duration
On the day of the procedure the area is disinfected and covered with sterile compresses. Depending on the extent, local anesthesia, analgosedation or general anesthesia is applied, so the patient feels no pain during the procedure. The whole course takes place in the sterile conditions of the operating room.
With drainage of an abscess the surgeon makes a small incision, releases the pus and rinses the cavity, and the wound is dressed. With an excision the entire affected tissue with the fistulous channels is removed, the bleeding is stopped, and the wound is — according to the plan — closed with sutures, left to heal gradually or covered with a flap or graft.
The duration depends on the extent: drainage of an abscess takes only a few minutes to half an hour, while a wide excision with reconstruction can take longer. With more extensive procedures under general anesthesia the anesthesiologist monitors the vital functions throughout the operation, so the procedure is safe and controlled.
After the procedure the patient recovers under the supervision of the staff. Smaller interventions allow a return home the same day, while more extensive excisions sometimes require a short stay for dressing changes and monitoring of the wound, which the surgeon decides.
Recovery after hidradenitis surgery
Recovery depends on the extent of the procedure. After drainage of an abscess relief is almost immediate, and the wound heals with dressing changes in the following days. After a wide excision recovery is longer, because the wound heals gradually — especially when it is left to heal secondarily, which requires regular dressing changes over several weeks.
Tidy wound care is decisive for a good outcome and for preventing infection. The patient receives clear instructions for dressing changes, and if needed follow-ups at the facility are arranged as well. In areas such as the armpit and groin it is important to relieve the skin, avoid friction and wear comfortable, breathable clothing.
What is recommended during recovery:
- change the dressing regularly and exactly according to the surgeon's instructions
- wear comfortable, breathable clothing and avoid friction in the wound area
- avoid strenuous activities and sweating until the wound has healed
- quitting smoking significantly improves healing and reduces recurrence of the disease
- maintain a tidy body weight and skin hygiene as a long-term measure
- contact the doctor if increased pain, pus, spreading redness or a temperature appear
Risks and possible complications
Surgical treatment of hidradenitis is safe and often the only path to lasting relief, but as with any procedure there are possible risks, of which the patient is informed in advance. They depend above all on the extent of the excision and the area being worked on.
Bleeding, wound infection, slower healing (especially in smokers and people with diabetes) and the formation of scars are possible, which, with extensive procedures, can limit movement in the armpit or groin. With insufficiently removed foci there is a possibility that the disease reappears, which is why with advanced forms it is important to remove all the affected tissue.
It is important to understand that hidradenitis is a chronic disease managed with a combination of surgery, therapy and a change of habits (above all quitting smoking and regulating body weight). Although a more extensive excision most reliably resolves a particular focus, long-term success also depends on consistent monitoring and the patient's cooperation. At Medical Time we therefore do not resolve only the current problem, but help the patient keep the disease under control.
Why have hidradenitis treated at Medical Time
At Medical Time we approach hidradenitis comprehensively and with understanding — from assessing the stage, through the choice of the right surgical technique, to support throughout recovery. An experienced surgical team and modern hospital conditions allow the procedure to be carried out safely, whether it is drainage of an abscess or a wide excision.
We attach special importance to explaining the nature of the disease to the patient and helping them manage it in the long term. After the procedure we stay with you for dressing changes, follow-ups, interpretation of the histological finding and advice on measures that reduce recurrence of the disease.
- a comprehensive approach — from drainage to a wide excision, according to the stage
- an experienced surgical team and modern, sterile hospital conditions
- a painless procedure under local anesthesia, analgosedation or general anesthesia
- carefully guided wound care and regular dressing changes until full healing
- an understanding of the chronic nature of the disease and support in long-term control
- advice on quitting smoking, body weight and skin care
- a discreet and careful approach, quick booking without long waiting
Price
The price of surgical treatment of hidradenitis depends on the stage of the disease, the extent of the procedure (drainage, limited or wide excision), the form of anesthesia and any reconstruction of the wound. The final price is determined after an examination; look at the surgical services in the price list, and you receive a precise estimate and an appointment by calling.
- Surgeon's examination and assessment of the stage
- Incision and drainage of an abscess
- Excision of the affected skin (limited or wide)
- Histopathological analysis of the removed tissue
For an estimate and an appointment, call 062-399-888.
Frequently asked questions about hidradenitis
No. Hidradenitis suppurativa is a chronic inflammatory skin disease linked to hereditary tendency, hormonal factors, smoking and body weight — not to uncleanliness. Hygiene is important as a supporting measure, but it is not the cause of the disease.
Hidradenitis is a chronic disease that is managed. A more extensive excision most reliably resolves a particular focus and prevents its recurrence, but long-term success also depends on therapy, quitting smoking and regulating body weight. At Medical Time we help you keep the disease under control.
During the procedure you feel no pain, because it is done under local anesthesia, analgosedation or general anesthesia, depending on the extent. After the procedure mild pain and tenderness are possible, which are controlled with analgesics recommended by the doctor.
Drainage releases the pus and brings quick relief, but it does not remove the diseased tissue, so the focus can reappear. For a lasting solution an excision of the affected skin and fistulous channels is needed, which the surgeon decides according to the stage of the disease.
After drainage recovery is quick. After a wide excision the wound heals gradually, sometimes over several weeks, especially when it is left to heal secondarily with regular dressing changes. The exact duration depends on the extent of the procedure.
Yes, significantly. Smoking worsens the course of the disease and slows wound healing. Quitting smoking is one of the most important measures that reduce the recurrence of foci and improve the treatment result.
With more extensive excisions scars are unavoidable, but the surgeon takes care that the function and appearance of the area remain as good as possible. With smaller procedures the scar is limited. The goal is to remove all the diseased tissue with the best possible outcome.