How Do You Treat Hidradenitis Suppurativa Tunnels?

Hidradenitis suppurativa (HS) is a chronic skin condition in which lesions appear in areas where the skin rubs together like the armpits and groin. These lesions can leave rupturing wounds that drain pus. As this process repeats, tunnels can form under the skin connecting the lesions, and these can cause permanent scarring. A number of treatments are available, so work with your dermatologist to find the option that's best for you.

Hidradenitis suppurative tunnels are a feature of HS, an inflammatory skin condition that involves painful lesions deep under the skin. In time, tunnels, or sinus tracts, can form between the lesions. These lesions can appear anywhere but mostly occur around the groin, buttocks, underarms, and chest.

Also known as fistulas and sinus tracts, tunnels don’t appear in the early stage of HS, but they can occur if HS becomes moderate or severe. HS tunnels look like raised tracts beneath the skin. They sometimes come to the surface and drain pus.

Knowing the signs and symptoms of HS can help you get prompt treatment. In the early stage, HS is easier to manage. Early treatment may help prevent or delay complications.

• Are painful
• Recur persistently
• Last for days or months
• Resemble boils
• Occur deep under the skin
• Are often preceded by burning, stinging, warmth, sweating, or pain in the area for 12 to 48 hours
• Can rupture or burst and leak an unpleasantly smelling bloody discharge around the groin, buttocks, underarms, and chest

If you are prone to HS, the following conditions may make lesions more likely to occur:

• Hot weather
• Sweat
• Menstruation
• Weight gain
• Stress

As HS progresses, the lesions or abscesses can recur and become more frequent and widespread. “[Tunnels] can be small, single tunnels or numerous tunnels that aren't connected, or they can become connected under the surface to form a network of tunnels,” says Steven Daveluy MD, an associate professor and clinical educator in the Wayne State University department of dermatology in Detroit and a board-certified dermatologist.

According to Ahuva Cices MD, an assistant professor of dermatology at Mount Sinai in New York City, HS symptoms “can be exquisitely painful and debilitating” without treatment. Painful lesions and scarring can limit movement and even the ability to sit or rest comfortably, Dr. Cices adds.

It’s not exactly clear why tunnels form, but experts think that chronic inflammation plays a major role.

Dr. Daveluy notes that, in addition to inflammation, there are other contributing factors:

• Genetics
• The body’s immune response
• Extensive scarring due to lesions

Medications

• cyclosporine, an immunosuppressant drug that helps reduce inflammation
• corticosteroids, anti-inflammatory and immunosuppressant drugs that help with the body’s immune response
• methotrexate, often combined with other immunosuppressants
• retinoids, such as isotretinoin (Accutane)

Biologic Treatments

Biologics that may help manage HS include these types:

• adalimumab (Humira)

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• secukinumab (Cosentyx)

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• bimzelx (bimekizumab)

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• infliximab (Remicade), which is not approved by the U.S. Food and Drug Administration for HS but is used off-label to reduce inflammation

  [17]

Side effects vary for each biologic. The most common side effects are pain and redness at the injection site, and cold or flu-like symptoms. Biologics also raise the risk of infection.

Deroofing

A surgeon removes tissue on the skin’s surface to expose the tunnels so they can drain and heal.

Surgical Removal or Excision of HS Tunnels

To treat severe or persistent HS, a surgeon may remove the affected areas of skin, possibly repairing it with a skin graft.

Saline Injections

Surgery to Manage HS Tunnels

• Use a gentle deodorant and unscented skin-care products to avoid irritating the skin. Avoid rubbing or scrubbing the skin.
• Use an antimicrobial wash to cleanse the skin. “There is a common misconception that HS is related to being unclean or not bathing properly or frequently enough. I recommend that patients shower once daily and wash the affected areas,” says Cices.
• Use a warm washcloth as a compress to ease discomfort. Consider soaking a black tea bag and wrapping it in the cloth.
• Apply ice packs covered in a cloth to reduce pain and swelling.
• Trim or remove hair by laser or electrolysis so you can avoid shaving and waxing, which can cause irritation and inflammation.
• Avoid sweating and overheating. Try wearing loose clothing if it helps.
• Manage your weight, Cices advises, because a high body mass index may worsen the severity of HS and increase the risk of skin folds where lesions can form.

“While lifestyle modifications can influence disease activity, it is important to remember that hidradenitis is an inflammatory skin disease caused by the immune system going into overdrive,“ says Cices. “Individuals with HS should not assign blame or feel guilty. Rather they should feel empowered that there are lifestyle changes that can have significant effects on disease progression and symptoms.”

• Hidradenitis suppurativa tunnels can form if you have HS for a long time and don’t seek treatment.
• The tunnels can be painful and severely affect your physical and mental well-being, but treatment can help manage HS and prevent or delay the appearance of HS tunnels and other complications.
• Treatments include lifestyle measures, immunosuppressant drugs, and surgery.
• Speak with your doctor if you think you may have HS. Early treatment can be effective.