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.
How Do Hidradenitis Suppurativa Tunnels Develop? How They Develop 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. HS tunnels are long cavities that can form in any layer of the skin. They are lined with squamous epithelial cells, which are large, flat cells with a very small or no nucleus. These cells usually line blood vessels, the urethra, and other internal cavities.e60dc2a1-f33c-4a05-9b50-8e3e8e59762990252b09-6926-4404-9c02-d2b5dbaee8d7e60dc2a1-f33c-4a05-9b50-8e3e8e5976293bd2df61-f58b-494a-be22-d27096194276 HS lesions and tunnels can be painful and significantly affect your quality of life.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d665ba67-eb18-4749-825f-586f9cdc0251 Severe tunneling is linked to a worse outcome for the underlying HS condition, which may increase the risk of a variety of cancers later in life.e60dc2a1-f33c-4a05-9b50-8e3e8e59762979271cfb-c624-4810-a620-a5adea778aee But treatment can help improve symptoms and quality of life, and prevent HS from worsening, so early action is essential. Your healthcare provider will work with you to find the best options.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981360dfe-eab6-40a1-ab54-b1bbadbb89d7
Recognizing the Symptoms of Hidradenitis Suppurativa Tunnels Symptoms 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. Early HS lesions or abscesses present these symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e59762927ea93e2-e0ed-4e78-bce2-ba87d800eb1d 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. Early treatment can help manage HS and may help prevent tunnels from forming.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291dd5e555-7f47-4fdd-bd24-aa6e7923b6c1
What Causes Hidradenitis Suppurativa Tunnels? Causes It’s not exactly clear why tunnels form, but experts think that chronic inflammation plays a major role. When a hair follicle becomes clogged with keratin (a protein found in our skin and hair) and sweat (which can no longer flow out of the clogged hair follicle), bacteria tends to grow inside the hair follicle. This causes the hair follicle to burst, creating a deep nodule or abscess. As these lesions open and close during flare-ups, tunnels start to form beneath the skin over time.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d103a4f9-ceab-4d3a-8e63-d66b18817897e60dc2a1-f33c-4a05-9b50-8e3e8e5976290bd42941-56e0-4f5a-9533-54bd95d2d2fb Dr. Daveluy notes that, in addition to inflammation, there are other contributing factors: Genetics The body’s immune response Extensive scarring due to lesions Not seeking treatment for HS increases the risk that the condition will get worse, including the development of tunnels.e60dc2a1-f33c-4a05-9b50-8e3e8e59762980ebb975-e4fa-4791-a005-42cc7e067173
Medication for Hidradenitis Suppurativa Tunnels Medication Several treatments can help manage HS tunnels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4ca02b1-9128-4112-b107-c7e398a6c4c0e60dc2a1-f33c-4a05-9b50-8e3e8e59762930428b9f-e455-46ef-92cd-1a1e747049ebe60dc2a1-f33c-4a05-9b50-8e3e8e5976294935ab98-fdf2-42d5-b390-00095a6ed610 Medications Immunosuppressants work in various ways to dampen the immune system. This also means they help reduce inflammation.e60dc2a1-f33c-4a05-9b50-8e3e8e59762960233786-0dce-4c37-8042-f4fd55727c39 These immunosuppressants are used for HS: 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 Experts don’t know exactly why biologics work for HS, but these treatments help combat chronic inflammation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629df724592-0c95-4d70-83d0-05b708540482 Biologics that may help manage HS include these types: adalimumab (Humira)e60dc2a1-f33c-4a05-9b50-8e3e8e597629f50b8d56-36e3-4354-839c-72255f27a62c secukinumab (Cosentyx)e60dc2a1-f33c-4a05-9b50-8e3e8e597629583c75ea-d2f3-455f-ada2-ee03c1c3f3b2 bimzelx (bimekizumab)e60dc2a1-f33c-4a05-9b50-8e3e8e597629c53946f8-a66b-45ea-9d91-c860cc0354fb infliximab (Remicade), which is not approved by the U.S. Food and Drug Administration for HS but is used off-label to reduce inflammatione60dc2a1-f33c-4a05-9b50-8e3e8e597629a489e1f7-24b6-4fb3-a9b8-6818049eadbf 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.
Surgical Procedures for Hidradenitis Suppurativa Surgical Procedures If necessary, surgery can help manage HS tunnels. A doctor will numb the area with local anesthesia, then use a blade or other instrument to remove a tunnel, nodule, or both in one of these procedures.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5e9b28e-1cbe-4c7a-bcf2-c19c0bd65383e60dc2a1-f33c-4a05-9b50-8e3e8e597629b42dd5c8-c7b9-44f8-ae71-862f1e17ce97 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 A small study showed that injecting a saline solution into tunnels helped them drain and reduced redness and swelling.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296b72d7e8-210a-42e9-a788-a9974d7e3019 Surgery to Manage HS Tunnels In punch debridement, or limited unroofing, a surgeon removes an inflamed nodule, helping prevent the progression of abscesses or tunnels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b8911894-cccf-49fe-a368-7d5cc08ffdcf In laser therapy, a surgeon uses a carbon dioxide laser to locate and vaporize tunnels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c95e0be7-44c1-4bab-9de6-13cb08192b9a
Living With HS Tunnels Living With If you have HS tunnels, one treatment option is surgery to remove tunnels and scarring. You will need to work with a dermatologist on a skin and wound care plan, which means figuring out which medications suit you best and learning how to dress your wounds when lesions occur.e60dc2a1-f33c-4a05-9b50-8e3e8e59762955e5a749-01c7-4548-8e14-4bddeee35d40e60dc2a1-f33c-4a05-9b50-8e3e8e597629a4efd083-2384-4522-ab03-caa559e88b8d To promote healing and prevent infection, consider these ways to take care of your skin:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c05ed6d6-759e-429b-aa7a-b3a4f4f95c8c 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.”
The Takeaway 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.
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