Hidradenitis Suppurativa Surgery: Everything You Need to Know

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Hidradenitis suppurativa is a disease that appears as painful bumps under the skin. The bumps may be mistaken for boils or cystic acne and are usually found in areas like the groin or armpits.

Without proper treatment, hidradenitis suppurativa can get worse. In severe cases, especially when the disease has made tunnels under the skin, surgery may be necessary.

Surgery


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Surgical options include processes known as deroofing, excision surgery, and laser surgery.

Learn about the different surgical options for hidradenitis suppurativa.

What Is Hidradenitis Suppurativa Surgery?

While some patients with hidradenitis suppurativa see improvements with a treatment plan of skin care and medications, other patients who experience more severe forms of the disease may be candidates for surgery.

There are a number of surgical options for hidradenitis suppurativa. Some can be handled in a doctor's office while others take place in a hospital.

Procedures a dermatologist may recommend include:

  • Botulinim toxin: Also known as Botox, an injection of this prescription compound may help reduce sweating, which can reduce infections in people with hidradenitis suppurativa.
  • Incision and drainage: This procedure is performed to drain pus-filled lumps that can occur in hidradenitis suppurativa. It can help reduce pain and feelings of pressure. But in most cases, the abscesses will recur.
  • Deroofing: In this procedure, the doctor removes skin that covers either an abscess or a sinus tract, a tunnel leading from the surface of the skin deep into soft tissue. Once the skin is removed, an open wound is left to heal by itself.
  • Excision surgery: This surgery involves removing an entire lesion or tunnel. This typically leaves a large wound following surgery.
  • Laser surgery: In this procedure, a laser is used to vaporize lesions associated with hidradenitis suppurativa.

Potential risks

All surgeries and procedures carry some risks

Possible risks in hidradenitis suppurativa surgery include:

  • Wounds may be painful following surgery.
  • Wounds may have an odor.
  • Wounds may take a long time to heal.
  • Hidradenitis suppurativa may recur following surgical procedures.

Purpose of Hidradenitis Suppurative Surgery

Surgical options may be suggested for those who have severe hidradenitis suppurativa that has not responded to other treatments like medication. Surgery will remove the lesions associated with hidradenitis suppurativa.

A doctor may recommend a surgery for those who have lesions that are extensive or persistent and causing considerable discomfort.

Surgery for hidradenitis suppurative can result in large wounds because not only does a lesion need to be removed, but a wide margin of skin around the wound also needs to be removed. For this reason, surgery is only indicated for those with severe disease. Mild or moderate forms of the disease may be treated with medications and skincare.

How to Prepare

Preparations for surgery will vary based on the type of procedure and whether it is being performed in a doctor's office or at a hospital.

Location

Surgery for hidradenitis suppurativa may take place in a dermatologist's office or in a hospital. Your doctor will be able to advise you on what would be the most appropriate for your situation.

If in-hospital, surgery may be performed as an outpatient, and you will go home afterwards, in other cases, you may need to stay overnight so your wounds can be monitored.

What to Wear

You can wear loose comfortable clothes to surgery, but there are some things you shouldn't wear if you are having surgery. These include:

  • Jewelry
  • Makeup
  • Nail polish
  • Contact lenses

Food and Drink

You will be given instructions about when you need to stop eating and drinking prior to your procedure. It is important to follow these instructions. 

Medications

You should tell your doctor ahead of time what medications you are taking, including prescription and over-the-counter (OTC) medications.

Follow the advice of your doctor about what medications to take in the lead-up to surgery and on the day of surgery.

In most cases, you will be able to continue taking medications, including blood thinners, before surgery. But always follow the advice of your doctor on what to continue taking.

What to Bring

Any valuable items or jewelry should be left at home. You may like to bring a book or something to pass the time as you wait for surgery.

Pre-Op Lifestyle Changes

You may be asked to stop smoking before your procedure.

What to Expect on the Day of Surgery

Exactly what will happen on the day of surgery will vary depending on whether you are having your procedure in a doctor's office, in a hospital as an outpatient, or in a hospital as an inpatient.

Before the Surgery

If you are having surgery as an outpatient in a hospital or outpatient facility, the following will happen before surgery:

  • You will be given hospital clothes to change into.
  • You will be given an ID bracelet.
  • You will be asked a number of questions, including your name, age and medical history.
  • You will speak with your anesthesiologist, the doctor who will administer the anesthesia, and surgeon prior to surgery.
  • You may be asked to sign a consent form if this has not already been done.
  • You will be given anesthesia.

During the Surgery

Depending on where you are having surgery and which procedure is performed, you will be given either a local anesthetic to numb the area around the surgery or general anesthesia to put you in a sleep-like state. If you are given a local anesthetic, you will be awake during the procedure.

The doctor will perform the procedure and may apply gauze and dressings to your wounds.

After the Surgery

Following surgery, you may have dressings on your wounds. You may experience some pain and discomfort.

If surgery was extensive, you may be kept in hospital for a few nights for wound care.

Recovery

Surgery for hidradenitis suppurativa can be more complex than other skin surgeries as surgery may involve removing a large area of the skin. This can mean recovery and healing can be a slow process.

Healing

Wounds may take four to eight weeks to recover and, in some people, this can take much longer. In the case of laser surgery, it can take up to six months for the skin to fully heal.

Coping with Recovery

For the first 10 days following surgery, changing dressings may cause pain. You may need to ask for assistance from family or friends to help change your dressings.

Sometimes, wounds may be accompanied by an odor. To reduce the smell, you can use a washcloth soaked in diluted white vinegar and apply it to the area before re-dressing the wound.

Antiseptic washes may help to reduce pain in the area.

Possible Future Surgeries

It is possible hidradenitis suppurativa will recur after surgery. If a second surgery does need to be performed to remove lesions, it is typically easier than the first surgery.

A Word From Verywell

Hidradenitis suppurativa can be a painful and embarrassing condition, but there are treatment options available. In severe cases, your doctor may recommend surgery.

There are a number of surgical options available for hidradenitis suppurativa, but recovery can be a slow process and may be painful. If you are unsure which treatment options are best for you, or you are concerned about your health, you should speak with your doctor.

Frequently Asked Questions

  • How effective is hidradenitis suppurativa surgery?

    Surgery for hidradenitis suppurative may be effective for patients with severe disease. There are a number of surgical options and rates of recurrence are variable. Local excision surgery has a recurrence rate of 22%, wide excision surgery has a recurrence rate of 13%, and deroofing has a recurrence rate of 27%.

    Wide excision surgery is often considered more effective than local excision surgery.

  • When can you have hidradenitis suppurativa surgery?

    Your doctor will advise you if you are a candidate for hidradenitis suppurativa surgery. Generally, surgery is only indicated for those with severe disease.

  • How do you manage HS without surgery?

    There are a number of ways to manage hidradenitis suppurativa without surgery. These include:

    • Medications
    • Skin care plans
    • Wound care
    • Pain control

    However, if the disease is extensive and severe, your doctor may still recommend surgery.

  • What does HS surgery aftercare involve?

    Recovery from hidradenitis suppurativa surgery can take some time. If you have dressings, you will be taught how to care for them, and you may need to change these dressings regularly.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Dermatology Association. Hidradenitis suppurativa: overview

  2. American Academy of Dermatology Association. Hidradenitis suppurativa: diagnosis and treatment.

  3. National Organization for Rare Disorders. Hidradenitis Suppurativa

  4. Michigan Medicine. Hidradenitis suppurativa: things to know and what to expect. Updated February 2019.

  5. Johns Hopkins. Preparing for surgery.

  6. Johns Hopkins. Preparing for dermatologic surgery

  7. Johns Hopkins Medicine. Surgery, what to expect.

  8. Manfredini M, Garbarino F, Bigi L, Pellacani G, Magnoni C. Surgical and postsurgical wound care in hidradenitis suppurativa. Dermatol Ther. 2020;33(3):e13282. doi:10.1111/dth.13282