Wide Excision in Hidradenitis Suppurativa, Does It Modify the Course of Disease?

Butrón-Bris B*, Fernández-Bernáldez A, Reymundo A, Lladó I, Rodríguez-Jiménez P, Gallo E, Navarro R, Daudén E and Delgado-Jiménez Y

Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain

^*Correspondance to: Beatriz Butrón Bris 

 PDF  Full Text DOI: 10.25107/2474-1647.3188

Abstract

Background: Hidradenitis suppurativa management is considered to be multidisciplinary. All the guidelines include surgery as part of the therapeutic scheme. Nevertheless, there is a lack of studies assessing whether surgery of problematic areas is useful for overall control of the disease. Objectives: The aim of our study was to evaluate the disease course in patients with hidradenitis suppurativa who underwent wide excision of complex fistula tracts. Methods: In a retrospective study we reviewed all patients with a diagnosis of hidradenitis suppurativa who underwent wide excision surgery between October 2018 and February 2020 at Hospital Universitario de la Princesa in Madrid. Demographic and clinical variables were collected. Fistula tracts were classified according to criteria defined by Martorell et al. The types of reconstruction and immediate complications of surgery were taken into account, as well as flares and antibiotic therapy. Disease severity was assessed by the International Hidradenitis Suppurativa Severity Score System (IHSSSS). Results: A total of 11 patients and 13 interventions were included. Most of the patients were obese (63.7%) and smokers (81.8%). The majority presented a moderate to severe stage (Hurley II and III). Anatomical areas treated were: Axilla (7) followed by the inguinal (3), genital (2) and gluteal regions (1). All patients had been treated with several cycles of antibiotics before surgery and three of them with adalimumab. Six type B fistulas, 6 types C and one type D were surgically intervened. After 6 months of followup recurrence was detected only in one case and most remained free of flares (45.4%) or suffered a single flare (27.3%). The use of antibiotic therapy was reduced significantly after surgery. Conclusion: Wide excision of complex fistulas seems to produce an overall effect on the inflammatory activity in hidradenitis suppurativa that may be important to achieve an adequate control of the disease

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Butrón-Bris B, Fernández-Bernáldez A, Reymundo A, Lladó I, RodríguezJiménez P, Gallo E, et al. Wide Excision in Hidradenitis Suppurativa, Does It Modify the Course of Disease?. Clin Surg. 2021; 6: 3188. Copyright © 2021 Butrón-Bris B. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Article Published: 26 May, 2021 Abstract Background: Hidradenitis suppurativa management is considered to be multidisciplinary. All the guidelines include surgery as part of the therapeutic scheme. Nevertheless, there is a lack of studies assessing whether surgery of problematic areas is useful for overall control of the disease. Objectives: The aim of our study was to evaluate the disease course in patients with hidradenitis suppurativa who underwent wide excision of complex fistula tracts. Methods: In a retrospective study we reviewed all patients with a diagnosis of hidradenitis suppurativa who underwent wide excision surgery between October 2018 and February 2020 at Hospital Universitario de la Princesa in Madrid. Demographic and clinical variables were collected. Fistula tracts were classified according to criteria defined by Martorell et al. The types of reconstruction and immediate complications of surgery were taken into account, as well as flares and antibiotic therapy. Disease severity was assessed by the International Hidradenitis Suppurativa Severity Score System (IHSSSS). Results: A total of 11 patients and 13 interventions were included. Most of the patients were obese (63.7%) and smokers (81.8%). The majority presented a moderate to severe stage (Hurley II and III). Anatomical areas treated were: Axilla (7) followed by the inguinal (3), genital (2) and gluteal regions (1). All patients had been treated with several cycles of antibiotics before surgery and three of them with adalimumab. Six type B fistulas, 6 types C and one type D were surgically intervened. After 6 months of followup recurrence was detected only in one case and most remained free of flares (45.4%) or suffered a single flare (27.3%). The use of antibiotic therapy was reduced significantly after surgery. Conclusion: Wide excision of complex fistulas seems to produce an overall effect on the inflammatory activity in hidradenitis suppurativa that may be important to achieve an adequate control of the disease. Butrón-Bris B*, Fernández-Bernáldez A, Reymundo A, Lladó I, Rodríguez-Jiménez P, Gallo E, Navarro R, Daudén E and Delgado-Jiménez Y Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain Introduction Hidradenitis Suppurativa (HS) is a chronic inflammatory disease characterized by painful abscesses, scars and sinus tract formation. HS prevalence in Europe is high (1%), while its mean incidence is 6 per 100,000 person-years [1]. The multidisciplinary treatment of the disease includes medical therapies such as antibiotics, retinoids, anti-inflammatory drugs and biologics (anti-TNFs such as adalimumab), as well as surgical options. In this context, wide excision of chronic and scarring lesions (complex fistulas) seems to be the most effective technique, which also provides lower rate of recurrences and adequate esthetic results [1-4]. The combination of medical and surgical treatment, especially in advanced states, is accepted as the correct management to regulate HS disease activity. Moreover, when the source of inflammation is eliminated (recurrent inflammation areas), the immunomodulatory treatment could be more effective controlling the emergence of new lesions a.