Surgical Treatment in Hidradenitis Suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic, progressive inflammatory disorder of follicular occlusion with pubertal onset that presents as painful inflammatory nodules, sinus tracts, and tunnelling in apocrine-gland-rich areas, such as the axilla, groin, lower back, and buttocks. The disease course is complicated by contractures, keloids, and immobility and is often associated with a low quality of life. It is considered a disorder of follicular occlusion with secondary inflammation, though the exact cause is not known. Management can often be unsatisfactory and challenging due to the chronic nature of the disease and its adverse impact on the quality of life. A multidisciplinary approach is key to prompt optimal disease control. The early stages can be managed with medical treatment, but the advanced stages most likely require surgical intervention. Various surgical options are available, depending upon disease severity and patient preference. In this review an evidence-based outline of surgical options for the treatment of HS are discussed. Case reports, case series, cohort studies, case-control studies, and Randomized Clinical Trials (RCT)s available in medical databases regarding surgical options used in the treatment of HS were considered for the review presented in a narrative manner in this article.

Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review

“…There are various options for surgical intervention, requiring an individualized strategy that considers multiple factors such as the types of lesions, inflammation activity and patients’ preferences [ 185 , 186 ]. In general, surgical intervention in HS is mostly reserved for advanced cases with irreversible tissue destruction, such as sinus tracts, scars and contractions [ 187 ].…”

“…Deroofing describes a superficial removal of the skin covering an inflammatory nodule or a solitary sinus tract, exposing the partially epithelialized basis of the lesion with subsequently curettage of the gelatinous granulation tissue [ 190 , 191 , 192 ]. The advantages of this procedure are its simplicity, cost-effectiveness and that it can be performed under local anesthesia, qualifying this method for treatment of inflammatory nodules, abscesses and solitary sinus tracts [ 186 ]. In a small study with 44 patients undergoing deroofing of axillary or inguinal HS lesions, 87% were recurrence-free in the follow-up interval of five years [ 193 ].…”

“…Excision describes the complete removal of the affected tissue and represents a more invasive surgical approach in HS. Depending on the extent of resection experts differentiate between limited, wide and radical excisions; however, there are no generally accepted definitions and distinctions between surgical interventions are blurred [ 186 ]. Van Rappard et al defined limited or localized excisions as the complete excision of the affected tissue, beyond the borders of activity, leaving clear margins [ 196 ].…”

Sexual Dysfunction and Quality of Life in Patients with Hidradenitis Suppurativa and Their Partners

“…HS was originally only regarded as a cutaneous disorder, but today, a growing body of evidence links HS with several dermatological and nondermatological comorbidities, such as metabolic syndrome, inflammatory bowel disease, cardiovascular risk, depression or anxiety, among others [8][9][10][11][12]. The management of this disease is a combination of medical therapies and surgical techniques [13,14].…”

Management of scarring HS fistulas with intralesional steroids

“…3 According to literature data available to date, surgery (standard, deroofing or laser) remains the gold standard to manage fibrous fistulas. 6 However, the excellent results by Sechi et al place steroid infiltrations as an important bridge between medical and surgical therapy representing one of the few studies to investigate them in chronic lesions that are already scarring. Although our results are different, the ability of intralesional steroids to act on and reverse fibrosis lays an important basis for future studies on this topic with uniform outcomes, standard methodologies and a better definition of fistular patterns.…”