Here’s what to expect from HS tunnel surgeries, including the most alternatives, complications, and recuperation suggestions.
Managing discomfort, sores, and other symptoms is a key priority for patients suffering from hidradenitis suppurativa (HS), a skin disorder in which abscesses form beneath the skin. According to the Academy of Dermatology, HS frequently results in the formation of “tunnels” that connect these lumps under the skin, causing even more agony and the possibility of consequences.
“These tunnels are more common in patients with severe and long-standing HS.” “They can be painful and sometimes drain fluid or pus,” says Dr Adil Moulanchikkal, Lead Ayurveda Skin Specialist at EliteAyurveda Clinics. Tunnels, according to researchers, are caused by repeated inflammation of hair follicles, as well as the formation of abscesses and scarring.
Fortunately, there are treatments for HS, including surgery. We’ll go through all you need to know about the various surgical treatments available, from how they work to aftercare advice.
HS Surgery options – Allopathic Perspective
According to Dr. Adil, the purpose of HS treatment is to break the cycle of inflammation so that your skin can heal. Your allopathic doctor may prescribe antibiotics, hormone treatment, or biologic medications. These treatments can help reduce symptoms like pain and redness, but they can’t make tunnels disappear (which become more common the more severe your HS is and the longer you’ve had it).
Your doctor may pick one of the following surgical techniques to eliminate tunnels and provide you with relief:
Drainage and incision. This treatment, also known as lancing, can help reduce pain from a flaring tunnel. It’s frequently used as a first step for bigger abscesses to assist decrease the wound area before deroofing. Your doctor will numb the region before making a skin cut to remove the pus from the tunnel. “The problem with incision and drainage is that the lining remains, so the lesions pretty much always come back and cause more problems,” “Because deroofing only requires a couple more steps and has a much higher cure rate, it’s recommended that providers treating HS use deroofing instead of incision and drainage.”
Roof replacement surgery. A deroofing operation, as the name implies, removes the skin that forms the top of the tunnel to allow the skin below to heal. “After numbing the tunnel or tunnels, the roof of the tunnel is removed with a scalpel or laser.” “The lining is then scraped away, and the tunnels are left open to heal,”. After that, you should only have a little scar with no tunnel underneath. “There is a risk that the tunnel will reopen, but the risk is very low, occurring only between zero and 14% of the time,” he explains.
Excision – Another procedure involves removing the skin all the way around the tunnel, down to the layer of fat beneath. “It’s important to have a discussion with the person doing your surgery about where you both think the tunnel may extend to, to make sure the entire area is numbed up before anything starts,”. These operations can be performed in the office while you are awake or under general anesthesia, with the latter being more likely if your tunnel spans across a wider area. Wounds are frequently left open to heal as well as feasible with excision, as with deroofing. “Sometimes doctors will use skin grafts, skin flaps, or stitches to close the open skin after tunnel excision, but this raises the risk that they will reappear,”. Depending on the type of repair, these operations may result in a shorter recovery period and additional scars.
Cryo Insufflation – .Because this is the newest surgical therapy for HS, many doctors may not offer it because more study is needed to back up its usefulness, according to Dr. Daveluy. According to Dr. Adil, “it usually doesn’t require any analgesia or numbing because it’s only a little uncomfortable.” Typically, numerous treatments are required.” While some small trials have demonstrated effectiveness, it is unclear how consistently beneficial this technique is.
Possible Surgical Complications
When medication alone is not enough to manage the painful or bothersome symptoms of HS tunnels, surgery is usually the next step and is the recommended treatment for tunnels, with the ultimate goal being to permanently heal them. However, even after surgery, there is a chance that tunnels will form again.
The degree of risk varies depending on the surgical treatment. Which is the greater danger. Because HS is a systemic illness, treating one area of skin does not prevent the disease from spreading to another. Outside of the treated region, new tunnels will frequently form.
A recent study discovered a 35% recurrence incidence among HS patients who underwent surgery.
There are always hazards associated with every medical practice. According to Dr. Adil, all skin operations, for example, include a risk of bleeding or infection. “Scarring will also result from these procedures, and the appearance of that scarring will vary greatly,” she says.
There is also a chance of stitching popping if you have stitches from your surgery. “Excisions where the skin is sewn up at the end have a high risk of the stitches falling apart and the wound opening up, especially if the HS disease and inflammation are not well-controlled at the time of the surgery,” explains Dr. Adil.
Another potential risk of surgery is post-operative pain, albeit this pain may still be less severe than regular HS discomfort. “Many patients report that the pain following surgery is actually less intense than the pain of HS before surgery,” explains Dr. Adil.
Finally, contractures are a possibility with HS. Contractures are scars that limit range of motion due to how tightly they have healed. According to Dr. Adil, this consequence is especially common in the armpits or groin areas, which are commonly afflicted locations in HS: “For example, a contracture in the armpit could limit you from raising your arm over your head.”
HS treatment from an Ayurveda Perspective
Hydradenitis suppurativa is a cause of Kapha and Pitta dosha, according to Ayurveda. When the digestive fire (Agni), or Pitta, is out of equilibrium, the Kapha Dosha becomes vitiated, causing metabolism to slow down. Because of the disturbance of fat molecules, they begin to accumulate in muscles and obstruct physiological passages, resulting in painful, swelling sores in the groyne, buttocks, thighs, and armpits.
Affected individuals may feel it in their armpits, buttocks, breasts, groyne, or inner thighs. Furthermore, a foul-smelling fluid that can abruptly leak may fill the painful lesions of HS.
Second, I’ll go through other HS treatments other than Surgery.
Topical therapies may assist to clear up the damaged area, reduce inflammation, or speed up the healing of lesions. Topical therapy for HS include antiseptic creams and acne medicines. Although they do not directly address the disorder’s underlying cause, they can help to alleviate some of its symptoms.
Corticosteroids are medications that are used to alleviate swelling, inflammation, and pain. They can be taken orally or via injection. Side effects of oral corticosteroids include elevated blood pressure, weight gain, and mood swings. Long-term use can also lead to osteoporosis, high blood sugar, and skin thinning.
Androgen is one hormone that may have an effect on HS. Furthermore, hormonal fluctuations throughout the menstrual cycle, pregnancy, and other times may exacerbate HS symptoms. Oral hormone therapy (monotherapy) is an option for mild to moderate HS, and it may be supplemented with other therapies for severe HS. Hormone therapy for women may induce blood clots as a side effect if used during pregnancy. Men may also have lower libido and ejaculatory problems.
Retinoids – Vitamin A is the source of retinoids, which are medications. They work by inhibiting skin cell multiplication and can also reduce inflammation. Pregnant women should avoid using oral retinoids since they increase the risk of congenital abnormalities. Furthermore, possible side effects include chapped lips, dry skin, and temporary hair loss.
Biologics – Biologics are modified forms of natural proteins derived from human cells. Biologics may help your body create a defence against HS by focusing on immune system components that induce inflammation.
Because biologic drugs target your immune system, they can increase your risk of infection. These drugs may also increase the likelihood of cancer, but this has yet to be proven.
As a side effect of biologics, nausea, headaches, and back pain may occur. Severe side effects include heart failure and autoimmune nerve problems. Furthermore, biologics may increase your risk of infection and lymphoma. Always explore the benefits and drawbacks of this treatment with your doctor.
Medicines for HS involving biologics, antibiotics or hormone therapy come with their own set of side effects like impacting the immune system balance (Biologics), or impacting the microbiome balance (antibiotics), or leading to hormonal imbalance (hormone therapy)
Finally, how may Ayurvedic treatment from a skilled professional help with HS reversal?
Ayurveda prioritizes detoxification (Shodhana therapy) and refers to it as kushtha yoga. Ayurvedic treatment focuses on giving Panchakarma, which ensures that the problem does not reoccur. It will also balance the doshas and strengthen their ability to control everything in the body.
The following are some treatment options for hidradenitis suppurativa:
1. Detoxification: Ama is eliminated from the body by drinking detoxifying herbal medicines.
2. Internal drugs: These are provided to balance all doshas in accordance with physiological processes. The medications could include Varanadi Kashayam, Triphala Guggulu, Gandhaka Rasayana, and others. Repeated detoxifications assist the body in removing extra ama.
3. External applications: These entail massaging herbal oils and preparations into the scarred areas.
In addition to the main course of treatment for Hidradenitis suppurativa, we recommend a Vedic diet and exercise. This helps to restore a poorly managed metabolism and balances the doshas in the body.
All of these are effective in treating the disease and preventing its recurrence.
In Ayurveda, hidradenitis suppurativa Treatment is to restore the body’s natural equilibrium by detoxifying it with potent herbal therapies.
The treatment for Hidradenitis Suppurativa at Elite Ayurveda comprises balancing the Kapha and Pitta doshas, as well as providing harmony to the metabolism. The treatment comprises body detoxification, internal drugs to balance doshas, and external applications to heal scars.
The treatment involves combinations of herbs created based on individual Prakruti and Vikruti analysis. Visit our website to know more
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Medically reviewed by Dr Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics. With over 15 years of experience in treating Neurological, Skin & Autoimmune Diseases.
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