Factors Affecting Healing in the Treatment of Hidradenitis Suppurativa

Abstract

Background Hidradenitis suppurativa (HS) is a chronic debilitating condition. Treatment of HS depends on disease stage, goals of care, access to care, and frequency of symptoms. We present our experience with surgical treatment for patients with HS. Methods Patients were followed longitudinally for at least 2 years postsurgical intervention. Demographic data, participation in a multidisciplinary program, type of surgery, healing rates, and potential factors contributing to wound healing were retrospectively reviewed in all cases using multivariate analysis. Results Two hundred forty-eight patients met the inclusion criteria with a total of 810 involved sites. Overall, 59% of patients had Hurley stage 3 disease at the time of surgery. Healing rates of 80% were observed in stages 1 and 2, and 74% were observed in stage 3. Hurley stage was not a significant predictor of healing (P = 0.09). Surgical treatment consisted of 38% incision and drainage, 44% excision without closure, and 17% excision with primary closure. Incisional and excisional treatments healed 78% and 79%, respectively, at 2 years. Primarily repaired defects (grafts and flaps) were 68% healed at 2 years. Observed healing rates were uniform regardless of the number of sites involved (P = 0.959). Participation in the multidisciplinary program was the strongest predictor of healing (78% vs 45%, P = 0.004). Sex, age, body mass index, tobacco use, diabetes, presurgery hemoglobin, and family history of HS were statistically not significant. Continuation of immune modulating therapy within 2 weeks of surgery was a predictor of reduced healing (odds ratio, 0.23; P = 0.004), whereas holding biologics for at least 2 weeks was not significant (odds ratio, 1.99; P = 0.146). Conclusions Participation in a multidisciplinary program is a strong predictor of long-term success when treating HS. Hurley score and number of involved sites did not correlate with successful healing after surgery. If taking biologics, we identified 2 weeks as an appropriate break from biologics before and after surgical intervention. Healing rates were highest with ablative procedures (incision and drainage, excision) alone.

Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists

“…The majority ( n = 11) of these studies reported on the use of antibiotics and biologic medications, with only two mentioning retinoids [ 47 , 62 ]. Of these, one study discussed post-surgical use of biologics [ 18 ], four studies detailed use of biologics and antibiotics in the weeks or months preceding surgery [ 37 , 39 , 56 , 63 ], three detailed antibiotic and/or biologic use both pre- and post-surgical intervention [ 41 , 46 , 64 ], one detailed intraoperative use of a gentamicin sponge [ 11 ], and two studies did not specify exact timing [ 47 , 54 ]. Prens et al [ 46 ] reported significantly longer healing times with the use of adalimumab (five patients) and infliximab (one patient) started several months before surgery, held for 1–2 weeks perioperatively, and then re-instated postoperatively within 1–2 weeks.…”

“…Prens et al [46] reported significantly longer healing times with the use of adalimumab (five patients) and infliximab (one patient) started several months before surgery, held for 1-2 weeks perioperatively, and then re-instated postoperatively within 1-2 weeks. Worden et al [64] performed a multivariate logistic regression analysis to analyze factors that negatively impacted healing and found a significant negative impact on healing if immune modulating therapy (infliximab, adalimumab, prednisone) was not held at least 2 weeks before surgery. Only one study detailed the use of adjuvant biologic therapies, including infliximab (eight patients) and ustekinumab (three patients) initiated 2--3 weeks after closure and continued for an average of 10.5 months [18].…”

Therapies for hidradenitis suppurativa: a systematic review with a focus on Brazil

“…The Hurley staging system of HS is a clinical intuitive classification useful for surgical planning. 7 , 9 , 25 , 28 , 29 , 37 , 44 , 49 , 57 , 60 , 63 Scoring systems, such as (Hidradenitis Suppurativa Clinical Response (HiSCR), 1 , 5 , 37 , 38 , 51 and HS Physician’s Global Assessment (HS-PGA), 9 , 23 , 50 have been developed to determine efficacy of interventions. The modified Sartorius Score 50 , 51 and International Hidradenitis Suppurativa Severity Score System (IHS4) 1 , 41 are both used as severity indexes and outcome measures.…”

Immunomodulatory drugs alone and adjuvant to surgery for hidradenitis suppurativa/acne inversa—A narrative review

“…Continuation of such a treatment within 2 weeks of surgery is a predictor of reduced wound healing (Odd's ratio, 0.23; P = .004), while discontinuation is not. 88 There an urgent need to address the other open questions with controlled trials to further improve the outcome in HS/AI patients.…”

“…On the other hand, immune modulating drug therapies can interfere with necessary surgical interventions. Continuation of such a treatment within 2 weeks of surgery is a predictor of reduced wound healing (Odd's ratio, 0.23; P = .004), while discontinuation is not 88 …”