Title : Management of hydradenitis suppurativa with leech application-a clinical presentation
Abstract:
Hidradenitis suppurativa(HS) is a chronic inflammatory skin disease affecting apocrine rich areas of the body like axillae, groin, scrotal and vulval area. This disease results with painful nodules, abscess, sinus tracts and scarring involving follicular occlusion with follicular rupture and perifollicular lymph histiocytic inflammation leading to the development of clinical manifestations. Chronicity is the hallmark of HS characterised by recurrent flares and as well as pain, causing significant impairment of quality of life and becomes a challenge to physicians, dermatologist, pathologist and surgeons too. HS has a great impact on the patient quality of life deeply affecting social, working and psychological conditions. In Ayurveda, Susrutha (800BC), considers this disease entity as a Nadi Vrana (sinus disorder) and considers as one of the incurable entities. Therapies in the management of HS, in the past have consisted of long-term antibiotics, anti-androgens and surgery. Newer treatment like tumour necrosis factor - alpha inhibitors have given clinicians more options but still there is no gold standard treatment. Keeping these disadvantages, a traditional Leech therapy was adopted on 5 patients in Sumana Hospital, AP, India from November 2001 to August, 2023, where actual therapeutic application of leeches on the area of affected, for 10 weeks with in a span of one gap of application was adopted. The leech therapy with a set of standard protocol from classics of Ayurveda have been adopted & executed successfully. For a clinically relevant staging and disease severity assessment it is essential for the development of evidence based treatments, Hurleys staging of HR , the modified sartorius score and HS severity index ( HSSI) was considered as an objective assessment. The final results were subjected for statistical evaluation for a scientific validation of the work. This innovative approach with leech application has documented a level of evidence and strength of recommendation to contemporary research with its rational approach for the debilitating and devastating nature of HS.
