Reconstructive & Burn Surgery
Hidradenitis Suppurativa
“Proof that even sweat glands can hold a grudge — and that we can help them forgive.”
What is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS) is a chronic skin condition that causes painful lumps, abscesses, and tunnels (sinus tracts) to form under the skin — usually in areas where skin rubs together, such as the armpits, groin, under the breasts, or buttocks.
It occurs when hair follicles and sweat glands become blocked and inflamed, leading to recurring infections and scarring over time. The exact cause isn’t fully known, but it’s thought to involve a mix of genetic, hormonal, and immune factors. It is not related to poor hygiene, and is not contagious.
HS often begins after puberty (young adults). Women more likely to be affected but the disease tends to be more severe in men. Early recognition and management are key to controlling flare-ups and preventing long-term scarring.
Common Symptoms
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painful deep nodules.
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recurrent abscesses.
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pus discharge with unpleasant odor.
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sinus tract formation.
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scarring and skin thickening.
Symptoms often flare and subside over time.
Stages of Hidradenitis Suppurativa
Stage I
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Only isolated single nodule or abscess present.
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No scarring or sinus tracts seen.
Stage II
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Recurrent abscesses and nodules present.
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Sinus tract formation from abscess to skin are seen.
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Scarring present, in areas of spontaneous healing.
Stage III
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Extensive disease, with multiple abscesses and nodules.
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Interconnected sinus tracts from abscess to skin, and from one abscess to another, are usually present.
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Significant scarring and deformity seen.
Risk factors for HS
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Young adults (20-29 years).
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Smoking.
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Obesity.
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Hormonal influences.
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Polycystic Ovary Syndrome (PCOS).
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Positive family history.
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Biological sex.
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Women 3 times more likely to affected.
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Disease often more severe in men.
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Areas Commonly Affected
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axilla (armpits).
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groin and genital region.
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under the breasts.
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buttocks.
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inner thighs.
When to See a Specialist
Early consultation is advised if:
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painful lumps keep recurring.
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purulent discharge.
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lesions leave scars.
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daily activities are affected.
Delaying treatment can lead to more extensive disease.
Treatment of Hidradenitis Suppurativa
While there is no single cure for Hidradenitis Suppurativa (HS), effective treatment can greatly reduce flare-ups, pain, and scarring. The approach depends on the severity of the condition and individual patient needs.
Lifestyle and Medical Management:
Early and mild cases often respond to simple measures such as maintaining good hygiene, wearing loose clothing, and avoiding friction or shaving over affected areas. Medical treatment may include antibiotics, anti-inflammatory medications, or hormonal therapy to control infection and reduce inflammation.
Advanced Medical Therapies:
In moderate to severe HS, newer biologic medications that target the immune system can help control inflammation and prevent new lesions from forming.
Surgical Treatment:
When abscesses or sinus tracts are persistent or recurrent, surgical removal of the affected tissue offers long-term relief. Procedures may include incision and drainage for acute infections, limited excision for small areas, or wide excision with reconstruction for more extensive disease. Plastic and reconstructive techniques help restore smooth, healthy skin and reduce recurrence.
Long-Term Care:
Because HS can be a chronic condition, ongoing follow-up and supportive care are essential to maintain comfort, function, and confidence.
Complications of Hidradenitis Suppurativa
Hidradenitis Suppurativa can be persistent and sometimes lead to long-term effects if not managed early. Understanding its possible complications helps guide better care and prevention.
Chronic Pain and Discomfort:
Recurrent abscesses can cause ongoing pain, tenderness, and drainage, making daily activities and movement uncomfortable.
Scarring and Skin Changes:
Repeated inflammation and healing may lead to thickened scars, pits, and tunnels (sinus tracts) under the skin. Over time, these can restrict movement or cause cosmetic concerns.
Infection:
Active lesions can become secondarily infected, leading to swelling, pus discharge, and occasionally fever if not treated promptly.
Restricted Mobility:
When HS affects areas like the armpits, groin, or thighs, scar tissue and tenderness can limit movement and flexibility.
Emotional and Social Impact:
Because HS often affects visible or sensitive areas, it can lead to embarrassment, self-consciousness, or social withdrawal. Supportive care and reconstructive options can greatly improve both appearance and confidence.
Rare Complications:
In long-standing, severe cases, chronic inflammation may rarely lead to skin cancer (squamous cell carcinoma) in affected areas — another reason why early treatment and monitoring are important.
With timely management and advanced surgical care, most patients experience excellent control and a major improvement in quality of life.
Book Consultation — Hidradenitis Suppurativa in Pakistan
Dr. Saud Majid, Plastic & Reconstructive Surgeon, provides comprehensive management of Hidradenitis Suppurativa, including definitive surgical treatment for advanced cases, with a focus on long-term disease control and quality of life.
Consultation includes:
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disease staging.
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discussion of medical vs surgical options.
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surgical planning when required.
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long-term management guidance.