Hidradenitis Suppurativa Surgery Frequently Asked Questions

Hidradenitis suppurativa (HS) is a chronic, recurrent, and progressive inflammatory disease that causes sweat glands to become inflamed, resulting in swollen and typically painful bumps. The disease is also known as acne inversa or Verneuil’s disease.

HS affects approximately 1 percent to 4 percent of people.

The onset of disease symptoms usually occurs between puberty and age 40, peaking in the second or third decade of life. HS most typically affects patients between the ages of 18 and 29 years.

Although the exact causes of HS are debated, the following activities may be triggering factors for HS:

• Smoking
• Obesity
• Wearing clothing that is tight or non-breathable

Those suffering from other medical conditions, including arthritis, severe acne, inflammatory bowel disease, Crohn's disease, metabolic syndrome, and diabetes, are also at a higher risk for developing HS.

Yes. HS is more common in women and people of African, Middle Eastern, and Asian descent.

HS can present with varying forms of severity. The Hurley clinical staging system classifies the disease into three stages:

• Stage I (Mild): Abscess formation (single or multiple), no sinus tracts or scarring.
• Stage II (Moderate): Recurrent abscesses with sinus tracts and scarring, single or multiple separated lesions.
• Stage III (Severe): Diffuse or almost diffuse involvement, or multiple interconnected sinus tracts and abscesses across the entire anatomical area.

• Stage I (Mild): Local care, topical agents, topical or oral antibiotics, abscess drainage.
• Stage II (Moderate): Extended oral antibiotic suppression therapy, abscess drainage, excision of lesions.
• Stage III (Severe): In addition to the above treatments, immunotherapy and surgical excision and reconstruction of the area.

HS is isolated to areas where apocrine sweat glands exist: the axilla (armpit), groin, buttocks, breasts, and perineal and anal areas.

The presentation and degree of the disease vary, both in anatomical location and severity. Generally, the earlier the age of onset, the more severe and widespread the disease.

Not every patient gets the disease in every anatomical location. In some patients, the disease is isolated to the axillary area, while in others, multiple anatomical locations are involved simultaneously. Involvement of more than one anatomical area is usually associated with increased severity of the disease.

Patients with a long-standing history of the disease may suffer from more severe symptoms, due to the disease’s recurrent and chronic nature.

Untreated or inadequately treated HS will eventually progress into more advanced forms of the disease. As HS advances and the symptoms become more severe, medical treatments tend to be less effective. Surgery is often the only option to treat advanced HS.

Surgical procedures to treat HS vary based on severity and individual patient needs.

Early stages of the disease can be treated with drainage of individual abscesses and cysts, followed by excision and removal of small involved areas. Removal of these areas decreases the amount of affected skin. However, this solution does not prevent new abscesses from forming in other areas.

There is no known medical cure for HS. However, the surgical team at UPMC offers a novel surgical treatment involving total removal of the disease in each anatomical area with almost no recurrence.

Surgeons in the UPMC Department of Plastic and Reconstructive Surgery use an innovative approach to effectively treat advanced cases of HS. Our surgeons remove all skin and tissue affected by the disease and reconstruct the area using nearby, uninvolved tissue.

For example, if the axilla (armpit) is affected, a surgeon will completely remove all HS-prone tissue and skin from the area, leaving behind only clean and uninvolved tissue. The surgeon will then use the patient’s nearby healthy tissue to cover and resurface this anatomical area. Due to the lack of apocrine sweat glands in the nearby tissue, HS will not recur in the axilla. This is the definitive solution to clearing HS from any anatomical area.