Hidradenitis Suppurativa Incision and Drainage: 4 Facts To Know | myHSteam

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Hidradenitis Suppurativa Incision and Drainage: 4 Facts To Know

Medically reviewed by Steven Devos, M.D., Ph.D.
Posted on October 25, 2023

Many members of myHSteam report having trouble finding a doctor or surgeon who understands hidradenitis suppurativa (HS), which can lead to delays in effective medical treatment. One member shared, “I had surgery recently on my buttock for an abscess that I have been struggling with in pain for three years. Because so many doctors didn’t know what it was, it was hard for me to find a surgeon that I could trust.”

Incision and drainage (I&D) is a surgical procedure that’s been used to treat HS. During I&D, the surgeon cuts into an abscess and drains its contents by applying pressure. Then, they wash the area with saline. I&D is performed with local anesthesia and can temporarily relieve the pain and pressure of abscesses in HS.

However, there’s not a lot of evidence supporting I&Ds as a standalone procedure for severe HS. Here are some reasons why, along with options to consider instead.

1. I&D Is No Longer Preferred

I&D procedures provide almost instant pain relief. Unfortunately, they fail to provide long-term benefits and may cause harmful side effects. The recurrence rates after I&D are nearly 100 percent. This means that nearly everyone who has an I&D procedure will see a return of symptoms.

“I’m having a flare-up on the scar tissue of a previous incision and drainage operation,” one myHSteam member reported.

I&D dissolves the pressure inside of an abscess, but it doesn’t address the surrounding tissue. As a result, I&D leaves the door open for recurrence and complications, especially when it’s performed outside of a medical facility.

2. Occasionally, I&D Is Still Recommended

If you’re struggling with a particularly painful abscess, your doctor may still suggest I&D to relieve extreme pain. However, it’s important to understand that I&D isn’t a solution for the long-term treatment of HS.

“I had an abscess lanced and drained today,” shared a myHSteam member. “I’m in severe pain, but I’m having surgery on Wednesday to remove the rest of the infection from the sinus tract.”

If your doctor recommends I&D, don’t be afraid to ask follow-up questions about the possibility of recurrence and what they recommend for preventing painful flare-ups in the future. You can also ask about other surgical procedures that are used to treat HS.

3. It’s Not Safe To Self-Lance at Home

Self-lancing is the practice of cutting into an abscess on your own without your doctor’s supervision. This practice is always dangerous because of the risk of infection. However, when HS is present, self-lancing is not only risky but also doesn’t address the root cause of the issue, meaning it won’t solve the problem.

Members of myHSteam have discussed their desire to self-lance despite the dangers. “I’ve read not to pop your cysts or boils, but that’s exactly my attitude. Pop this. Get it out of me as fast as possible. Get it over with, and immediately hit it with a Q-tip doused in alcohol. It burns badly, especially when you’ve popped it, and it’s open. But to me, it’s totally worth it to get some relief and mobility back.”

Dermatologists discourage squeezing or puncturing HS cysts and nodules. Although you might think it’ll help, injuring your skin can make HS worse or cause infections. Safer options may include applying a warm compress to the affected area and discussing a wound care plan with your health care provider.

4. Other Surgical Treatment Options Are Available

Surgery may be reserved for more severe cases of HS in areas that aren’t responding to other forms of medical management, like oral contraceptives or biologics (medications made from living organisms, such as cells). However, surgery can also be appropriate if you don’t have severe disease.

Several surgical techniques and reconstruction options can be considered and offer better results than I&D. An experienced surgeon can go over the best choices for your situation and discuss the risks and outlook. Two options are deroofing and excisions.

Deroofing

Deroofing, also called unroofing, is a procedure that takes the same amount of time and uses the same equipment as I&D. Many surgeons prefer deroofing for HS because it’s minimally invasive (causes less damage to the body compared to traditional open surgeries) and offers better outcomes than I&D. Deroofing may be recommended for early-stage lesions.

First, the surgeon strips the cover or “roof” of an abscess or sinus tract to expose the “floor” of the lesion. Then, they gently locate all tracts and deroof them and use surgical tools or moistened gauze to remove sinus tissue and allow for healing.

In one study cited in the Journal of Clinical Medicine, participants took an average of two weeks to heal from deroofing on areas that were about 3 centimeters long. After 34 weeks, 83 percent of the treated lesions did not return. Most people felt satisfied by the results, and 90 percent said they would recommend deroofing to others.

Excision

Surgeons may also recommend wide or localized excisions to help treat HS. In a wide excision, the surgeon removes the affected skin along with 1 to 2 centimeters of surrounding tissue. Wide excisions may be reserved for severe cases with additional complications, like extensive scarring.

Local excisions remove diseased skin but avoid removing healthy skin. You may be a good candidate for a local excision if you have an abscess that keeps coming back or smaller, early-stage lesions. Large lesions can’t be removed with a local excision because there’s a limit on how much lidocaine can be used to manage pain during the procedure.

Wide excisions are more invasive but have low recurrence rates of just 13 percent (compared to 22 percent after local excisions), according the Journal of Clinical Medicine study. Because a larger part of skin is removed with every excision, this procedure cannot be repeated indefinitely. Depending on the location and size of the excision, you may need additional reconstructive surgeries using healthy skin grafts.

Make Informed Decisions

I&D is performed with local anesthesia and can provide temporary relief from the pain and pressure caused by abscesses in HS. But remember, treating HS effectively often involves a broader strategy, which may include different medical and surgical treatments customized to your specific needs. It’s vital to consult with a health care provider to make the most effective decisions in managing your HS.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 36,000 members come together to ask questions, give advice, and share their stories with others who understand.

Do you have early-stage or severe hidradenitis suppurativa? Have you undergone any surgical procedures? How have they affected your quality of life? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on October 25, 2023
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Steven Devos, M.D., Ph.D. received his medical degree and completed residency training in dermatology at the University of Ghent, Belgium. Learn more about him here.
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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