Service
Hidradenitis suppurativa
Hidradenitis suppurativa is a chronic inflammation of the skin that appears where skin touches skin — under the armpits, in the groin, under the breasts, in the cleft between the buttocks. Painful nodules, abscesses and tunnels under the skin appear, which recede and then return.
What concerns does it address?
Why does it occur and why does it come back?
Hidradenitis is not an infection that you “catch”, nor a question of hygiene. It is a chronic inflammation that begins with a blocked hair root in places where skin touches skin and sweats; the root ruptures, the inflammation spreads deeper and over time forms tunnels under the skin (fistulas) and scars. That is why it returns in the same places, why antibiotics help only temporarily and why squeezing makes it worse. It is more common in smokers and with a higher body weight, and the tendency is partly inherited. A dermatologist makes the diagnosis and leads treatment with medicines; surgery comes in when medicines no longer keep it under control or when tunnels and scars have formed.
How is it done?
Depending on the stage, one of three things is done. Opening and drainage of an acutely inflamed nodule — quickly relieves pain and pressure, but does not treat the cause, so the inflammation in that spot often returns. Opening the tunnels (deroofing): the roof of the tunnel under the skin is removed and the floor is left to heal from the inside — a smaller wound, and it comes back less often in that spot. Wide excision of the whole affected area of skin with its tunnels and scars — in advanced disease; the wound is left to heal by itself, stitched or covered with a skin graft, depending on its size. The larger the area and the higher the stage, the larger the procedure, which is done under general anaesthesia, sometimes in several stages.
In which place?
- Under the armpit, in the groin, under the breasts, in the cleft between the buttocks — the typical places.
- A single lump that does not come back and does not hurt — more likely a sebaceous cyst or a lipoma. → Sebaceous cyst · Lipoma
- Only in the cleft between the buttocks, with an opening and small hairs — it may be a pilonidal sinus.
→ Pilonidal sinus surgery
When is the procedure not suitable?
An acutely inflamed, tense nodule with pus is not a reason for postponing but for opening. Wide excision is planned when the acute inflammation has settled and when a dermatologist has also assessed the condition — surgery is part of the treatment, not a replacement for it. In this condition smoking directly worsens both the disease and healing, so stopping smoking is agreed before a larger procedure.
General reasons for postponing a procedure (pregnancy, breastfeeding, inflammation, a clotting disorder, smoking): When is a procedure postponed?
Anaesthesia
Before a procedure under general or regional anaesthesia, you are seen by the anaesthetist, who works full time at the clinic; the same doctor is also present during the procedure. The anaesthetic assessment and the anaesthesia for larger operations are included in the price of the procedure. What happens before, during and after anaesthesia is described on the Anaesthesia page.
Recovery
Procedures are grouped into four recovery profiles: A, outpatient (home straight away, no restrictions apart from dressing changes), B, minor procedure (home the same day or after one night, marks are visible for about a week), C, major procedure (one to two nights in the clinic, sick leave and planning in weeks) and D, functional procedure (sick leave and return to work). This procedure belongs to profile A or B, depending on its extent. How long recovery takes and what it depends on is described on the Recovery after surgery page.
Risks
Occasional — slower healing of the open wound, the condition appearing again in the same or another place, a wider and firmer scar, tightness of the skin in the armpit or groin that needs exercises or correction.
Expected, and rare but serious → Risks and complications: what is the course of healing, and what is a complication?
Price
| Service | Price |
|---|---|
| Hidradenitis, incision | €200 |
| Hidradenitis, medium excision | €800–1,400 |
Specialist and team
Specialty: general surgery.
When the procedure is done under sedation or general anaesthesia, the anaesthesia is led by a specialist in anaesthesiology, resuscitation and intensive care who works full time at the clinic.
In the operating theatre, the surgeon is assisted by head nurse Martina Šereg, with the help of nurses Kristina Jurešić and Mateja Tomorad, and in recovery the care assistant Mirjana Kovačić is with you. Martina also looks after preparation, scheduling and contact after the procedure.
Who will operate is decided at the examination, based on the findings and the type of procedure. You know the name of the surgeon before the procedure and meet them at the examination.
What happens at the examination?
The first examination lasts 30 to 45 minutes on average. The surgeon examines the area you are concerned about, asks about illnesses, medicines, allergies and previous operations, and talks with you about what you expect. If the procedure is appropriate and likely to help, you receive a plan: which procedure is proposed, under which anaesthesia, what recovery looks like and what is included in the price. If the procedure is not needed or would not give you what you expect, you will hear that at the examination too.
What if the result is not as agreed?
The result of a procedure is assessed at a follow-up visit, once the swelling has gone down and the scar has matured, not in the first weeks. If it differs from what was agreed at the examination, the same surgeon carries out the correction.
→ Poliklinika Barbel's correction policy
Frequently asked questions
Is hidradenitis suppurativa a question of hygiene? No. It is a chronic inflammatory disease of the hair root, partly inherited; washing neither causes nor treats it.
How does it differ from an ordinary boil? A boil appears once and passes. Hidradenitis returns in the same places — armpit, groin, under the breasts, the cleft between the buttocks — and over time forms tunnels under the skin and scars. If your boils keep recurring in those places, it is hidradenitis.
Does the condition come back after the procedure? In a place that has been widely excised, with its tunnels and scars, it rarely comes back. On neighbouring skin or in another place it can appear again, because it is a tendency, not a single inflammation. That is why surgery is combined with treatment by a dermatologist.
Can I squeeze a nodule? No — squeezing pushes the inflammation deeper and helps tunnels to form. A tense and painful nodule is opened under local anaesthesia.
Do I need to see a dermatologist first? Yes, if you have not already: a dermatologist makes the diagnosis and leads treatment with medicines. If you already have a diagnosis and tunnels or scars, come for an examination directly — with your test results.
How much does the result depend on care after the procedure? The larger the procedure, the more it depends on it, but it always does. Healing takes weeks and months and happens almost entirely at home, so the instructions you receive when you go home, about the wound, physical activity and the scar, are part of the procedure, not a recommendation.
Medical review: doctors of Poliklinika Barbel · October 2026.