minor surgery for hidradenitis suppurativa

Do you have a mild case of Hidradenitis Suppurativa (HS)? Any stubborn spots that refuse to go away? I do, and I did. It’s an inflammatory skin disease that can make you feel embarrassed and alone, so I think it’s important to speak out about it. I’d like to share my experience with minor surgery to extract an HS cyst. I felt my options were limited and scary, but it’s turned out well (so far). Maybe I can assuage some of your fears.

HS is a condition that can make you feel embarrassed and alone, so I think it’s important to speak out about it.

I was diagnosed with HS in February of last year. I may have already had it for years, but the beginning of 2017 was when I developed a painful cyst in my right armpit that leaked an oily yellow fluid. I’ve been on low dose antibiotics since then, and that has kept the inflammation down enough that I haven’t developed any other lasting cysts. That original one, though, never went away. I already had a different surgery lined up for that summer, so I didn’t want to take drastic measures.

In the latter half of 2017, the skin around the cyst began to, well, disappear. I developed a small open wound that never healed, despite using hibiclens and ointment on it. The skin over the cyst began to bunch up as if it were drawing away from the rest of my skin. Then another open wound developed at the beginning of 2018. It was painful to wear a bra because the fabric or underwire might touch the wounds.

Last month, one year from my initial diagnosis of the same cyst, I decided enough was enough. I was no longer overwhelmed from my other surgery, so I asked my dermatologist what my options were to resolve the problem instead of hoping things would get better.

The aggressive choices boiled down to starting Humira, a biologic that would lower my immune system, or surgical excision of the damaged skin. Because HS is an inflammatory response disease, the autoimmune system is implicated. This is why Humira is used for HS. Since my antibiotic is working well for all areas except this one cyst, I was hesitant to try Humira.

I asked for more information on the excision. I was expecting to have to go to the hospital again and have an outpatient procedure, but it turned out to be so much easier than that.

My dermatologist said it was an in-office procedure that he would perform with local anaesthetic. I would have stitches for about 2 weeks. I didn’t have to be on medication or take time off from work other than for the procedure itself. If I’d realized how small the procedure was, I might have done it a long time ago.

On the day of the extraction, I left work at noon to head over to my dermatologist’s office. I wore a tank top without a bra and didn’t have to change into anything else. I lay back on an exam bed with my arm raised above my head.

The assisting nurse injected my armpit with local anaesthetic. This was honestly the most painful part of the procedure. It felt like liquid fire was being squirted into my skin. I mean… damn. There were probably 8 or so injections, and the last two were the worst. It kicked in really quickly, though, because it was only a few minutes before my doc got to cutting.

The nurse covered my side with white medical paper so my clothes were protected and the doc only had to worry about the surgery site. I couldn’t feel the damaged skin being cut away. Eventually my shoulder started to hurt from having my arm above my head for so long, but it was a small price to pay for a painless procedure. I only felt the suturing when the stitches were being tied. I couldn’t feel the needle, but I felt the tugging against my bodyweight.

I think the entire process took around 30 minutes. I received one set of dissolvable stitches under the skin and another set of four stitches on the surface. They told me to put ointment, like Neosporin, on the suture twice a day. Wash with soap and water. No deoderant or anything else on it.

The local anaesthetic wore off after around 4 hours. It hurt quite a lot that first evening, sort of a throbbing ache. The next day was also painful, although it was just an ache then. I slept poorly the first few nights because of the pain. Each day was a little better, and I barely noticed it by the end of one week. If I wore clothing that touched my armpit, the suture would be sore by the end of the day.

This past Monday, the exterior sutures were removed. It wasn’t painful other than a few tugs and stings. The interior stitches should dissolve in another two or three weeks. I don’t notice them. I don’t have to do anything special to the area and can put deoderant on it now, but I’m still keeping it chemical-free for the rest of this week, just to be safe. I do have a scar, but it doesn’t hurt. That makes it a huge improvement over the lump I had before.

I was pleased that my dermatologist got a histology done on the removed skin. He didn’t have to go deep, as it really was all lumped up on the surface. Turns out there was a cyst inside of the lump, so at least I know what was going on. Thankfully, there wasn’t anything unusual other than that.

So, that’s my HS cyst removal story. I know HS can be much worse than what I have and that some excisions are so extensive that they require skin grafts afterward. There’s also a chance of the HS recurring in that area. I realize it’s a risk for me, as well. Still, I’m very happy with how it went and would absolutely choose to do it again!

Have you had an HS surgery? Considering one? If you feel comfortable doing so, please share your experience. It helps to know we’re not alone.

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