HS and other autoimmune diseases have a significant effect on post-operative wound healing. We see slow healing, minor or major wound separations, and severe suture reactions in patients with HS. We are seeing some sort of healing problem in about 80% of our cleft lift patients with HS. In general, we have found the cleft lift procedure to ultimately be successful in HS patients, but with a significantly more difficult postoperative course, with wider and more irregular and prominent scars, and with recurrent skin infections in the months and years after surgery which are usually related to the HS, but can confuse the situation. These problems are not unique to the cleft lift procedure, and HS patients can have problems after any of the operations for pilonidal disease, but we have found that HS is the predominant issue in patients who have significant healing issues after a cleft lift. 

HS is considered a “clinical diagnosis”, which means that although there are classic signs and symptoms, there is no specific blood test, culture, or biopsy result that confirms the diagnosis. The classic symptoms are repeated infections in the groins and armpits. HS in the area around the anus is very common, but not often recognized. We have found that pilonidal wounds that are involved with HS have a characteristic appearance, and we have seen many patients with perianal HS without groin or armpit involvement.

Differentiating HS from pilonidal disease can be a challenge. If a patient’s infections are from HS, a cleft lift is not necessarily the answer, and may predispose to further problems. There are times when we see patients who had failed pilonidal surgery, and there is concern that the original diagnosis was incorrect – and the patient actually had HS rather than pilonidal disease, but there is no way to go back in time and figure it out.

In general, in any patient on Humira, prednisone (or any of the medications used to blunt the immune system) it is recommended that the medications be discontinued both before and after any kind of surgery because it creates a risk of infection and slows healing. But, in some situations it actually may be better to continue the medications to prevent post operative problems. At our clinic we evaluate this on a case-by-case basis, but in general we prefer to have the HS under good control at the time of surgery even if it means continuing these medications.

It is our recommendation that any patient with HS take a two pronged approach to treatment. We feel that they should have a dermatologist help with the diagnosis and treating the symptoms, but also have an autoimmune evaluation by an Functional Medicine physician. Even though a patient may have a genetic predisposition to these autoimmune diseases, if certain diet or environmental triggers can be determined and removed, there are times when the disease itself can be eliminated. The process of diagnosis and treatment of this problem can take months or years. Optimally, this is accomplished before pilonidal surgery is performed, but often this is not feasible.

If you have cleft lift surgery at our clinic and we suspect that you have HS, we may want you on medications for this even without a diagnosis by a dermatologist. We often use an oral tetracycline and topical clindamycin gel for at least 6 weeks post-operatively to prevent wound problems. If, in spite of these medications, problems persist, we will recommend dermatologic consultation.