Have you ever heard someone on social media mention, “I had my glands removed”? If so, you’re not alone! The idea of gland removal as part of Hidradenitis Suppurativa (HS) surgery is a topic many of us have encountered, but the details can often be misunderstood. Typically, when people refer to this, they mean the removal of apocrine glands, which .
Understanding Hidradenitis Suppurativa
HS can occur in any part of the body with hair follicles—this includes areas you might not typically associate with hair, such as smooth skin. The only exceptions are the palms, soles, and lips.
Gland Basics and Their Role in HS
Early Beliefs About HS and Glands
Initially, HS was believed to be a condition stemming from apocrine glands, particularly because it is common in apocrine gland-rich regions where skin rubs together (intertriginous areas). However, current research shows that HS primarily involves the hair follicle unit, including eccrine and sebaceous glands, leading to follicular blockages and inflammation.
The core issue in HS is the obstruction of the upper portion of the follicular unit, caused by an overgrowth of keratinocytes in the outer root sheath. This leads to a rupture of the follicle, releasing hair fragments, bacteria, and other debris into surrounding tissue, triggering inflammation. This inflammatory response is responsible for the painful abscesses associated with HS.
Advances in Understanding
Modern studies suggest impaired notch signaling as a primary factor in HS development. This signaling pathway is critical for the maintenance of hair follicles and skin structures. Mutations in this pathway have been linked to familial cases of HS, highlighting the role of genetic and immune factors. Disruptions here result in inflammation and immune dysregulation, driving tissue damage and immune cell recruitment.
Where Are These Glands, Anyway?
Apocrine Glands
Apocrine sweat glands are found in specific parts of the body, such as:
- Armpits
- Nipple area
- Ear canal
- Around the anus and genitals
- Nostril edges
- Specialized glands like those on the eyelids
Despite this, HS frequently occurs in areas without apocrine glands, further proving it is not solely a sweat gland disorder. Additionally, these glands become active only at puberty due to hormonal changes, yet HS can develop before puberty or later in life. With so many apocrine glands distributed across the skin, it is impossible to remove all of them.
Eccrine and Sebaceous Glands
Eccrine and sebaceous glands are found all over the body and are deeply integrated with hair follicles. Sebaceous glands are particularly abundant, making it impractical to remove them all. Procedures targeting sweat glands, such as those for hyperhidrosis, may address excessive sweating but do not resolve the root cause of HS.
The Shift Away from Gland Removal
A Misguided Approach
Decades ago, gland removal was considered a potential cure for HS, but this has since been debunked. HS is now classified as a follicular disease with inflammatory and autoimmune components, not a condition driven solely by sweat glands. As such, removing glands offers no guaranteed benefit and often leads to unnecessary surgeries without long-term success.
When Gland Removal May Be Considered
In cases where HS tunneling becomes severe, some specialists might use imaging to evaluate whether gland removal is necessary. However, these situations are rare and typically involve advanced stages of the disease.
Conclusion
HS is a complex disorder rooted in defective follicular processes, immune dysregulation, and inflammation. While glands can become affected by HS, they are not the primary driver of the disease. Instead, modern treatment focuses on managing inflammation and addressing follicular occlusion. As our understanding of HS evolves, gland removal is increasingly recognized as an outdated practice. Instead, wide excision surgeries without targeting glands have shown equal or better outcomes, reinforcing that this old approach is no longer the gold standard.
Watch Dr. Barry Resnik’s interview here
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