In our specialized Hidradenitis Suppurativa Clinic, patients are seen by the OB/GYN team of Dr. Constance Faro, Dr. Jonathan Faro and Dr. Sebastian Faro. All three physicians see each patient during the interview, examination, and post-examination counseling. During the post examination counseling, the physician team and the patient will determine the appropriate course of management.
Hidradenitis Suppurativa is the result of an inflammation of the hair follicle, and is a progressive disease. The disease can occur at any hair bearing area of the body. The most common areas are the axilla, vulva, mons pubis, and buttocks. Other areas, although less frequent, are the breast,abdomen, inner thighs, and back of the neck. The disease is often confused with a abscess under the skin, or a furuncle or carbuncle (boil). A common misconception is that this is due to an infection.
This misconception arises because the disease begins as nodule that is often tender or painful. The nodule can recede or develop into a fluid filled, often pus containing structure, that is referred to as an abscess. This abscess is sterile, not infected, in 50% of the case. These abscesses are painful, tend to rupture spontaneously and can drain copious amounts of pus, sometimes mixed with blood. When the abscess ruptures through the skin they also rupture into the fatty tissue below the skin. This can lead to the formation of sinus tracts leading to development of new abscesses. This progression leads to the formation of new lesions, draining sinuses through the skin and scarring. This is the progressive and spreading nature of this disease.
The best opportunity to achieve resolution is to diagnose the disease in the early stage. There are three stages of the disease:
- Hurley Stage I - isolated lesion, infrequently the patient may present with more than one lesion
- Hurley Stage II – patient typically has multiple lesions with little scarring
- Hurley Stage III – multiple lesions, draining sinuses, scarring
Disease that is diagnosed in Stage I usually responds to medical therapy. However, sometimes surgery is necessary and this can, in many cases, be accomplished with laser therapy.
Stage II disease is usually treated by surgical excision of the diseased tissue.
Stage III is treated with aggressive surgical excision of all involved tissue.
If the surgical approach is not aggressive there is a high recurrence rate (>50%). The recurrence rate with aggressive surgical excision can be as high as 25%.
Patients attending our specialty Gynecologic Hidradenitis Suppurativa clinic will first undergo a detailed history focusing on:
- When the disease first appeared.
- How often do you experience reoccurrences?
- Do you or have you used tobacco products? If so , how long? How many cigarettes a day do you smoke?
- Do you drink alcohol containing beverages? If so what do you drink, beer, wine, mixed drinks, or straight shots? How often do you drink?
- Does anyone else in your family have this disease?
- Do you have any medical illnesses, such as, Lupus, colitis, Sarcoidosis?
- Have you been treated for this condition? If so what treatments did you have?
Second, a thorough physical examination will be performed to determine the location of the disease and the stage of disease. The physician team will decide which laboratory tests are needed.
Third, a post-examination counseling session will be held with you and the physician team to decide on a course of management.
You will meet our nursing assistant, who is specifically designated to care for Hidradenitis patients. She will be in contact with you following the initial evaluation to check on the management, schedule appointments, and schedule surgery. She will also contact you following treatment to maintain contact until you return for post treatment appointments.
If you have Hidradenitis Suppurativa or if you think you may have this disease, call 713-383-9579 for an appointment. Tell our receptionist that you specifically need an appointment in the Hidradenitis Suppurative Clinic.
For more information about Hidradenitis Suppurative, please visit the Hidradenitis Suppurativa Foundation at http://www.hs-foundation.org.