Cleveland Clinic Abu Dhabi Offers Integrated Palliative Care for Chronic Skin Disease

Doctors at Cleveland Clinic Abu Dhabi, part of Mubadala’s healthcare network, are encouraging patients with skin conditions to seek medical treatment, as innovative therapies are now available in the UAE.

Patients with recurring inflammation, abscesses and scarring in the armpits, groins or under the breasts may be suffering from Hidradenitis Suppurativa, a long-term skin condition that occurs due to the inflammation of the apocrine sweat glands.

The condition more commonly affects females and is more pronounced in young adults, starting at puberty up to age 55. Globally, it affects 1 to 4 per cent of the population, but experts say this is likely underestimated because of underreporting and misdiagnosis.

“Hidradenitis Suppurativa is rarely life-threatening but can be extremely painful and cause a mental health challenge for patients. It is a disfiguring disease that affects sensitive areas causing embarrassment to patients, who shy away from seeking treatment. This leads to depression, anxiety and social isolation,” says Dr. Rafal Iskanderian, an Associate Staff Physician in the Digestive Disease Institute at Cleveland Clinic Abu Dhabi.

“The skin looks like it is burnt and is discolored because of chronic inflammation over the years. It starts with small painful lumps that recur and rupture, oozing pus after a few days. If not addressed, new lumps will continue to develop in the area nearby, making it more challenging to treat. Patients should find the right clinic when they begin to notice these changes, since a multidisciplinary approach can significantly improve their quality of life.”

Cleveland Clinic Abu Dhabi has now established a Hidradenitis Multidisciplinary Team, which includes general and plastic surgeons, dermatology and wound care experts, and psychiatry support and infectious disease experts, that provides modern comprehensive care to patients.

While the actual cause of the disease remains unknown, the lumps develop because of blocked hair follicles, causing an inflammation that spreads to neighboring sweat glands.

Dr. Iskanderian says the condition is genetic in about a third of all cases. “Lifestyle factors like smoking and obesity are also strongly linked to this disease. These patients are more prone to develop autoimmune disorders like inflammatory bowel disease, especially Crohn’s disease, diabetes and thyroid disorders. A multidisciplinary approach can also help with screening these potential disorders.”

Not addressing the issue on time, he says, can lead to serious chronic infections, sinus tracts and severe scarring. “A few skin cancer cases arising in chronic Hidradenitis ulcers have also been reported in literature.”

In its early stages, the disease can be managed by a prolonged antibiotic treatment plan and immunosuppressive therapy, but Dr. Iskanderian says that he has been seeing more patients in the late stages of the condition who require radical surgical excision of the diseased skin and staged reconstruction.

“When they present late, the skin is already irreversibly damaged and there is little chance to treat the inflammation with antibiotics or immunosuppressant therapy. We then must radically resect all infected skin and close the defect stage-by-stage. Ultimately, we can harvest a skin graft from the patient’s leg to reconstruct the affected area”.

A patient, who recently went through surgical excision, says that he began seeing the lumps in his armpits and genital area nine years back.  “I was always depressed and frustrated by the condition. I would be afraid to go near my kids. I would constantly take sick days and carry an extra pair of clothes if I visited the mall because the lumps could leak fluids.”

The 29-year-old patient says that antibiotics and immunosuppressive therapy were not working, and he opted for surgery to address the problem.

“The medical team at Cleveland Clinic Abu Dhabi conducted the excision and grafting, which went very well. The wounds are healing fast and I’m looking forward to a full recovery soon.”

Dr. Iskanderian adds that surgery does not cure the condition but reduces the recurrence of inflammation in the areas treated with surgery.

“This approach has made the patients that we treated more comfortable in their bodies and has helped them regain their lost confidence. They have required less hospitalization and the immunosuppressive therapy and antibiotics are working better to manage the residual minimal disease.”

The patient says that he can now have a normal life. “I can go out, drive a car, work-out, be with my kids, everything that I was missing out on for so long. Cleveland Clinic Abu Dhabi has a great medical team and their attention and ongoing care has changed my life.”

For more information or to book an appointment at Cleveland Clinic Abu Dhabi, call 800 8 CCAD (2223) visit or download the Cleveland Clinic Abu Dhabi app.

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