Ayurvedic management of typical and atypical presentation of Hidradenitis suppurativa (Nadivrana) in a young woman: A case report

Hidradenitis suppurativa (HS), or Verneuil’s disease, is characterized by recurrent chronic inflammation involving apocrine glands. It typically develops after puberty, greatly hampering the patient’s quality of life. The axilla, groin, buttocks, perineum, and inframammary areas are among the most typical sites for HS. Atypical HS is defined as HS that occurs at atypical sites such as scalp, eyelids, retro-auricular and preauricular skin, chest, thighs, abdomen, posterior neck, and legs. Lesions can also appear less frequently in areas with few or no apocrine glands. Ayurvedic classical texts described the disease Nadivrana (~fistula/sinus wound), having clinical features mimicking HS. This is the case of a 28-year-old young female with both typical and atypical sites presentation of HS for 12 years, which grew worse with the use of yeast products such as bakery items (bread, biscuits, and cake), during her periods, under stress, and improved with rest. Elimination of infection through Shodhana (~purification therapy) is the treatment principle of Nadivrana management . The patient was treated with Ayurveda therapies and oral medications to balance out the Dosha (~regulatory functional factors of the body) vitiation. After four months of treatment and six months of continuous follow-up, the symptoms of HS in terms of flaring, discharge, and redness subsided and no recurrence was noted until reporting this case.