General Questions

1. Which doctor should I see?

Depending on the severity of the disease it could be a dermatologist, a plastic surgeon or a proctologist. What is important is that the doctor knows about hidradenitis suppurativa (HS).

2. Is it a rare disease?

No, it affects an estimated 1% of the population. It is therefore a relatively frequent disease, but it is often not diagnosed. Many patients do not know what they have and are only told of their correct diagnosis after many years.

3. How do I distinguish between a simple boil and HS?

The location (groin and armpits), and the chro-nicity of the flares are important guidelines. That is to say, if a patient with HS has a lesion outside the predilection areas it is impossible to tell the difference.

4. Where can it develop?

Essentially in the armpits, between and under the breasts and the groin. It may also involve the glueal cleft and the perineum, and in some cases the entire ano-perineal-inguinal region. In rare cases it can involve buttocks, ears and other regions.

5. Can it affect the face?

No, except if it is associated with acne, which is not very frequent.

6. Is it a contagious disease? No.

7. Does it get worse with time?

One cannot say. Generally it is considered to be worst during the first few years, but there are exceptions to this.

No, except in very rare cases if cancer develops in one of the lesions and is not treated early enough. Historically amyloidosis has been described in untreated but chronically infected patients; but this probably no longer occurs.

9. What are the stages of the disease? Hurley's classification is used to classify the stages of the disease. Stage I is characterized by lesions, flares and sinus tracts that are separated from each other. In Stage II the flares are linked to each other by tunnels and/or by excessive development of thickened (hypertrophic) scar tissue. Stage III is characterized by the development of a large area of suppurating (oozing), fibrous tissue. In Stage III, surgery is the only effective treatment.

10. Is it necessary to operate when the first symptoms of the disease are diagnosed?

If the patient is suffering from inflamed lesions without chronic suppuration and without thick scar (hypertrophic) tissue, and especially in the case of a single lesion, it is best to try medical treatment. But surgery may be necessary in the early stages: an incision in a boil may be the only way to relieve the pain and empty it of pus, but the effect is short-lived and we do not recommend the procedure; the surgical removal of a single but chronic boil, or recurrent nodule in the same place, is an effective form of early treatment.

11. Why after surgery do I see new lesions appear in new areas?

New lesions appear after excision, but one can also see them appear in the absence of surgical treatment. The appearance of new lesions in new areas does not depend on whether or not surgery has taken place.

12. Can this disease be sexually transmitted? No.

13. Is this an autoimmune disease? In all probability not.

14. Is it a disease due to a hospital infection? No.

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