April 10, 2025 Author : Alberto Rocha Pereira (plastic surgery) Hidradenitis suppurativa is a chronic inflammatory disease that affects the skin folds. Acne inversa, Verneuil's disease and fistulous pyoderma are other names for this disease. It most frequently affects the armpits and groin but can also involve the buttocks and inframammary folds. Continuous drainage of liquid and the unpleasant odor compromise the quality of life of people affected due to the difficulties in sanitizing and cleaning the diseased areas, affecting the way people dress and organize their social and professional lives. The disease has very different presentations, which sometimes justifies its late diagnosis associated with prolonged suffering. Causes of hidradenitis suppurativa The cause of this chronic inflammatory disease, which results from obstruction of hair follicles and associated glands , is not completely known. It is known, however, that several factors contribute to its development : Genetic and familial, which explain the appearance in people from the same family; Hormonal, which justify the appearance after puberty; Immunological; Environmental and lifestyle-related, for example tobacco consumption, wearing tight clothing and obesity. It is also known that hidradenitis is not due to infections or poor hygiene . This common and incorrect judgment contributes to the discrimination that patients with hidradenitis suppurativa are frequently subjected to. Symptoms and diagnosis In the affected area, the most frequent symptoms are: Inflammation with redness and thickening; Painful and recurring skin nodules; Foul-smelling discharge; Thick, retractable scars that sometimes form “bridges” of skin; Difficulty in mobilizing the limbs due to pain and/or skin retraction. The diagnosis is clinical and can be made during a dermatology or plastic surgery consultation . It is based on the characteristic presentation and usually does not require additional tests. In the initial stages, hidradenitis suppurativa can be confused with folliculitis, sebaceous cysts and acne, but due to its progression and affected regions, it is easily identified, and treatment can be started. Treatment of hidradenitis suppurativa There is no definitive cure for hidradenitis suppurative. However, the disease can be controlled , depending on its stage of development, with the medicines and, if necessary, surgery . Medical treatment In the initial stages, treatment is medical and should be instituted by dermatology . The goal is to control inflammation, reduce flare-ups, stop disease progression and improve quality of life. Several types of medications can be useful, alone or in combination. Adjustments to medication may be necessary depending on individual response, so the consultation should not be abandoned at the first setback. Prescribed medications may include: Anti-inflammatories; Antibiotics; Retinoids; Hormonal therapies; Biological therapies (in moderate to severe cases). Surgical treatment Poor response to medical treatment, complications and more advanced stages of hidradenitis suppurativa require surgical treatment, which is performed by plastic surgery . Different interventions may be indicated depending on the specific case: Drainage of abscesses, which is reserved for the acute phase of individual lesions; Radical removal of affected areas; Reconstructive surgeries involving skin grafts or flaps. In most cases, removal of individual lesions is not indicated. However, draining them in the acute phase, infected with pus accumulation, can greatly alleviate the pain associated, as well as speeding up their control with associated antibiotic therapy. Plastic surgery aims to remove the affected areas of skin en bloc, with a higher density of hair follicles, in areas of greater friction and with a greater risk of inflammation and obstruction of hair follicles, which cannot, however, be eradicated completely. Due to the fact that these are areas of folds at the roots of the limbs, such as armpits and inguinal regions, and which therefore require great mobility, they will necessarily have to be replaced with skin of adequate thickness and elasticity so as not to impede movement. Reconstructive plastic surgery allows the transfer of skin flaps from adjacent areas, preferably with a smaller amount of hair, or, alternatively, flaps from distant areas are transferred using microsurgery techniques. Medical and surgical treatments are complementary Surgical treatment of hidradenitis suppurativa does not replace medical treatment, which should be maintained in addition . It also does not replace long-term monitoring, which is essential, since the malignant transformation of chronic scars that have evolved for decades cannot be ruled out. Surgical interventions must be performed in a hospital and under general anesthesia, as local anesthetics are not effective in inflamed and infected areas. Due to the particularities of the disease, the technical requirements and the very specific post-operative period, these are interventions that must be carried out by experienced plastic surgeons trained in the treatment of this disease , whenever possible involved in a multidisciplinary team. Meet the reconstructive and aesthetic plastic surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
