An Ayurvedic Approach to Hidradenitis Suppurativa: A Case Series

Abstract

Hidradenitis suppurativa is a chronic, disabling and suppurative disorder characterized by deep tender subcutaneous nodules complicated by fibrosis and extensive sinuses mainly affecting apocrine gland bearing areas. The estimated prevalence of the disease is approximately 1%. The commonly affected areas of the body includes underarms, under the breasts, inner thighs, groin and buttocks. Management of hidradenitis suppurativa includes complete surgical excision of lesion in single or multiple stages followed by skin grafting. But the procedure is very expensive and has increased chances of recurrence.^[1,2] Hence there is a possibility of parasurgical interventions which would be safer and cost effective. The clinical features of hidradenitis suppurativa can be compared with the concepts of Nadivrana mentioned in classics.^[3] Acharya Susrutha has mentioned Ksharasutra as the mode of management in Nadivrana. Ksharasutra application involves multiple actions such a Chedana (excision), Bhedana (Incision), Lekhana (Scraping), Sodhana (Purification), and Ropana (epithelialisation) so that unhealthy granulation tissue is completely removed from the track and promotes healthy healing.^[4] The line of management of the above disease further elaborates use of surgical interventions such as Chedana, Bhedana along with the application of Kshara and internal medications. An Ayurvedic protocol generated with a combination of para surgical interventions along with internal medications by analysing the disease with the concepts of Nadivrana Chikitsa was found effective in the 2 selected cases and a protocol was generated which can be a baseline for further clinical studies on larger samples to standardise the line of management of Hidradenitis suppurativa in Ayurveda.