What Heals Hidradenitis Suppurativa: Surgery, Immunosuppression, or Both?

Abstract

Recent trials demonstrating the safety and efficacy of biologic therapy alone in patients with moderate-to-severe HS have spurred questions regarding the potential utility of these agents as adjuncts to more traditional surgical interventions. The results of the literature search advocate a role for radical resection and biologic therapy in the setting of moderate-to-severe disease. Preliminary results from limited case series suggest a potential role for combined management in the setting of advanced, recalcitrant disease.

The efficacy and safety of endo‐radiofrequency for the treatment of hidradenitis suppurativa

“…According to current guidelines, several medical and surgical options are available for the treatment of HS however; they may not always result in satisfactory outcomes 1,12 . Due to relapse following discontinuation of most medical options and severe side effects and high recurrence rate with surgery methods, successful management of HS remains controversial and new therapeutic options are needed 6,13 . In this non‐randomized, single‐blinded clinical trial, we evaluated the efficacy of radiofrequency in the treatment of 10 patients with refractory axillary hidradenitis suppurativa.…”

“…1,12 Due to relapse following discontinuation of most medical options and severe side effects and high recurrence rate with surgery methods, successful management of HS remains controversial and new therapeutic options are needed. 6,13 In this nonrandomized, single-blinded clinical trial, we evaluated the efficacy of radiofrequency in the treatment of 10 patients with refractory axillary hidradenitis suppurativa. After a three-month follow-up period, patients' HS-PGA scores improved significantly and the HS-PGA scale showed a reduction in 90% of the cases.…”

Schweizer Praxisempfehlungen für die Behandlung der Hidradenitis suppurativa (Acne inversa)

“…Der Algorithmus empfiehlt verschiedene Behandlungsoptionen basierend sowohl auf dem Hurley-Stadium als auch auf verschiedenen Krankheitsmerkmalen: Entzündungslast, Verschluss von Follikeln, Persistenz der Läsionen und chronisch-intermittierender Krankheitsverlauf. Auch andere Autoren haben aktuell die Behandlungsmöglichkeiten für die inflammatorischen Krankheitsmerkmale einerseits und die nicht-entzündlichen Komponenten andererseits beschrieben [41,42,43]. Unser Algorithmus deckt sich hiermit zum Teil, bietet jedoch mehr Details auf der Grundlage einer ausführlicheren Klassifikation der HS-spezifischen Pathologie.…”

Wound Closure with Transcutaneous Absorbable Polyglactin Sutures after Hidradenitis Suppurativa Excision

“…Presentations of HS vary, ranging from recurrent, inflamed subcutaneous nodules to diffuse abscesses that coalesce to form sinus tracts emitting malodorous or purulent drainage. Radical surgical excision of diseased areas remains the standard treatment for severe HS in pediatric and adult populations 2–6 …”

“…Complicating matters, they tend to occur in moist, uncomfortable, and difficult-to-clean areas and are often closed under some tension following large excisions, substantially increasing the risk of postoperative wound complications. As with all high-risk wounds, providers must carefully consider the closure technique to optimize healing: primary closure, adjacent tissue transfer, grafting, or secondary intention 3,7,8 . When possible, a meticulous layered closure is encouraged to decrease tension, close dead space, and more precisely approximate wound edges.…”