Pyoderma Gangrenosum vs. Hidradenitis Suppurativa

March 20, 2025

Pyoderma Gangrenosum vs. Hidradenitis Suppurativa: Ayurvedic Perspective & Clinical Differentiation

Pyoderma Gangrenosum (PG) and Hidradenitis Suppurativa (HS) are chronic inflammatory skin disorders that can be misdiagnosed due to overlapping clinical features like painful ulcers, abscesses, and non-healing wounds. However, their pathophysiology, triggers, and treatment approaches differ significantly.

At EliteAyurveda, we emphasize precise diagnosis and root-cause-based treatment to ensure effective, long-term healing using Ayurveda’s holistic approach.

Pyoderma Gangrenosum vs. Hidradenitis Suppurativa

🔍 Understanding the Differences: PG vs. HS

1️⃣ Pyoderma Gangrenosum (PG)

✔ Autoimmune condition characterized by painful, rapidly progressing skin ulcers.
✔ Commonly associated with Inflammatory Bowel Disease (IBD), Rheumatoid Arthritis, and Blood Disorders.
✔ Lesions start as small pustules or nodules that break down into deep ulcers with violaceous (purple) borders.
✔ Excessive inflammation leads to severe tissue destruction.
✔ Pathergy phenomenon: Skin trauma triggers ulcer formation.

2️⃣ Hidradenitis Suppurativa (HS)

✔ Chronic inflammatory skin disease affecting apocrine gland-bearing areas (axilla, groin, under the breasts).
✔ Linked to hair follicle occlusion, bacterial overgrowth, and immune dysregulation.
✔ Painful nodules and abscesses that may rupture, forming sinus tracts and scarring.
✔ Progresses over time, leading to fibrosis, fistula formation, and recurrent infections.
✔ Strong association with metabolic syndrome, obesity, and hormonal imbalances.

🩺 Clinical Diagnosis: How to Differentiate PG from HS?

Feature	Pyoderma Gangrenosum (PG)	Hidradenitis Suppurativa (HS)
Primary Lesions	Painful ulcers with purple borders	Painful nodules, abscesses, and sinus tracts
Location	Legs, arms, abdomen	Armpits, groin, buttocks, under the breasts
Onset	Sudden, rapid progression	Gradual, chronic course
Triggers	Trauma (pathergy), autoimmune diseases	Hair follicle blockage, metabolic syndrome
Scarring	Ulcers heal with cribriform scars	Significant fibrosis and contractures
Systemic Association	IBD, arthritis, hematologic diseases	PCOS, obesity, insulin resistance
Bacterial Culture	Sterile, no infection	Often positive for secondary bacterial infection
Pain Level	Severe, persistent pain	Moderate to severe pain, varies by stage

🌿 Ayurvedic Approach to PG & HS: Healing from Within

In Ayurveda, both PG and HS arise due to imbalanced Pitta and Vata doshas, leading to excess inflammation, improper wound healing, and tissue destruction. However, the underlying causative factors differ, requiring a personalized treatment approach.

1️⃣ Personalized Herbal Formulations for Skin Healing

✔ For PG:
🔹 Pitta-pacifying herbs to reduce excess immune response.
🔹 Blood purifiers (Rakta Shodhana Dravyas) to eliminate deep-seated toxins.
🔹 Rasayana herbs to accelerate wound healing and tissue regeneration.

✔ For HS:
🔹 Kapha-Vata balancing herbs to prevent hair follicle occlusion & infection.
🔹 Anti-inflammatory and detoxifying herbs to reduce nodules & sinus tracts.
🔹 Medicated lepas (herbal pastes) for external application on abscesses & scars.

2️⃣ Detoxification Therapies (Shodhana) for Long-Term Healing

✔ For PG:
✅ Virechana (Purgation Therapy): Removes deep-seated inflammatory toxins.
✅ Raktamokshana (Bloodletting): Purifies the blood and prevents ulcer formation.

✔ For HS:
✅ Basti (Medicated Enema): Balances Vata, reducing pain & scarring.
✅ Lepam (Herbal Paste Application): Promotes abscess healing and reduces fibrosis.

3️⃣ Diet & Lifestyle Modifications for Symptom Control

✔ PG Healing Diet:
🔹 Avoid spicy, acidic, and processed foods that aggravate Pitta.
🔹 Include cooling foods like coconut water, aloe vera, ghee, and cucumber.

✔ HS Symptom Management Diet:
🔹 Avoid dairy, sugar, and fried foods that increase Kapha.
🔹 Focus on anti-inflammatory foods like flaxseeds, turmeric, and green leafy vegetables.

✔ Lifestyle Adjustments for Both Conditions:
✅ Maintain hygiene to prevent secondary infections.
✅ Manage stress with meditation and pranayama.
✅ Avoid excess sweating and friction in HS-prone areas.

🗣️ Doctor’s Insight

“Both Pyoderma Gangrenosum and Hidradenitis Suppurativa require precise diagnosis to ensure the right treatment plan. Ayurveda provides a holistic, long-term solution by addressing the root causes and balancing the body’s natural healing mechanisms.”
— Chief Ayurvedic Consultant, EliteAyurveda