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Hidradenitis Suppurativa Expert

Living with Hidradenitis: Ask the Expert


Hidradenitis Suppurativa (HS) is a lifelong skin problem that is associated with recurrent folliculitis of the hair follicles, abscess formation, pus-pockets, fistulas, pain, swelling, and scar formation in areas with skin-to-skin friction. The most common areas that Hidradenitis occurs is in the armpits, groin area, pubis, inner thighs, and breasts. Hidradenitis is more common in women, but may occur in men as well.


Newly-diagnosed patients often ask if Hidradenitis is curable, and the answer is not yet clearly defined. Certainly, there are many patients who no longer have recurrent Hidradenitis Suppurativa lesions after treatment, but they always have a finite risk that the problem may recur. It is very important to 1) receive treatment from an expert in the field and 2) seek early treatment for your cysts and abscesses. It is also very important to address associated symptoms that are affecting your quality of life. Hidradenitis is a difficult problem to manage; and Dr. Raffy Karamanoukian can help you find the right solutions for Hidradenitis in his Los Angeles plastic surgery center.


Diagnosing Hidradenitis Suppurativa:

Hidradenitis diagnosis has become more advanced over the years. In the past, it used to be associated with apocrine dysfunction, but new research has emphasized the role of follicular occlusion in Hidradenitis Suppurativa. That being said, you will read later about how effective laser hair removal is as a treatment in educing Hidradenitis flare-ups below.


Hidradenitis Suppurativa occurs in 1% of the general population, which means that for every 100 people you meet, one of the them will likely have Hidradenitis. There are also genetic factors that may cause Hidradenitis, which means that you may have relatives that have the problem as well. About one-third of patients with Hidradenitis have a family history of the disease.


The top experts in Hidradenitis Suppurativa treatment use the Hurley Classification System in addition to a full examination and evaluation. The Hurley system helps gauge how bad your Hidradenitis is in order to objectify management decision-making.



A full examination and history-taking is necessary to understand the severity of your Hidradenitis. Most experts agree that three criteria should generally be met to diagnose Hidradenitis: 1) The onset of Hidradenitis lesions (pustules, folliculitis, abscesses), 2) The location of the lesions in the axilla, groin, pubis, inner thighs, scalp, or breasts), and 3) recurrence of the problem over and over.


Health Problems:

Dr. Karamanoukian will evaluate your health at the same time as your Hidradenitis Suppurativa examination to exclude comorbid health problems that are typically associated with Hidradenitis. These health problems include 1) Obesity, 2) Acne, 3) Lipid disorders, 4) Depression or Anxiety, 5) Diabetes, 6) PCOS Poly-cystic ovaries, 7) High blood pressure, and 8) Keratosis pilaris.

Quality of Life:

Hidradenitis may affect your quality of life, sexual relations, social interactions, and generalized psychological well-being. Anxiety, social isolation, sexual distress, and depression are common findings with Hidradenitis. If you feel comfortable discussing these problems with Dr. Karamanoukian, please do so as he will be able to help you find help for your particular concerns.


Pain continues to be a very important component of Hidradenitis Suppurativa treatment. Symptoms of pain, itching, burning, soreness, and inflammation can make the Hidradenitis abscesses burdensome and distressing. Topical agents, NSAIDS, opioid analgesics, and non-opioid analgesics are used to help alleviate pain symptoms. Inflammation can also increase the pain burden on a patient, often necessitating more aggressive therapy.


Treatments for Hidradenitis:

Hidradenitis requires a combination of medical and surgical management, depending on the amount of symptoms and the severity of the problem. Reducing bacterial colonization, follicle burden and density, and inflammation risk can help the disease severity and recurrence rate.


Topical management of Hidradenitis with Clindamycin antibiotic washes or pledgets; combined with systemic oral-dose antibiotics take advantage of the immunomodulatory and anti-inflammatory effects of low dose antibiotics. Short-term steroid use under a physician’s management can also be effective in reducing Hidradenitis flares.


Biologic Agents:


Adalimumab and Infliximab are both effective as TNF alpha-inhibitors used for moderate to severe Hidradenitis.


Laser Hair Removal:


Recurrent folliculitis is a common feature in adolescent and adult men and women who present with hidradenitis suppurativa. There seems to be a long-term involvement of folliculitis and hair-follicle related abscesses that may aggravate or even cause Hidradenitis. Laser hair removal is an excellent option in patients who have recurrent Hidradenitis as it can ablate abnormal hair follicles without surgery. Laser hair removal uses selective photothermolysis as the primary therapeutic action to destroy hair follicles. In our office, laser hair removal can be safely applied to all skin types, including dark skin.


If you have recurrent folliculitis, ingrown hairs, and hidradenitis suppurativa, our clinicians can help you reduce the need for painful shaving and waxing in the areas. Unlike waxing, laser hair removal can be a permanent solution for your problem. Dr. Karamanoukian will also combine the laser hair removal with targeted treatments to reduce Hidradenitis flare-ups.


Surgical Management:

Local excision, scar revision, scar excision, abscess incision and drainage, deroofing procedures, sinus tract excision, fistula excision, and incision therapy are excellent options that can complement the medical management of Hidradenitis. Top expert Dr. Karamanoukian can help you identify and undergo effective surgical strategies for your condition.


Wound Care:

Dr. Karamanoukian is a double board certified surgeon and expert in the management of chronic wounds. He will guide you through the process of wound care should your Hidradenitis flare-up result in a long-lasting wound. Modern wound dressings can help improve wound healing. 


Insurance Verification: 

Insurance often covers the cost of medical and surgical treatments for Hidradenitis Suppurativa. Insurance coverage varies by provider and by beneficary policy. Our office can help you verify eligibility for treatment with Hidradenitis. Our office accepts Out-Of-Network PPO insurance, including Aetna, United Healthcare, Cigna, Anthem, and Blue Cross / Blue Shield


Insurance coverage for United Healthcare, Aetna, Cigna, and Anthem for Hidradenitis Los Angeles

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