Factors influencing the local cure rate of hidradenitis suppurativa following wide local excision

Abstract

Wide local excision is the gold standard and only potential curative therapy for recalcitrant hidradenitis suppurativa. However, high recurrence rates persist even post-surgery with little known on the influencing factors for remission. We evaluated the effect of patient, disease, and operative factors on local cure rate of moderate to severe hidradenitis following wide local excision. We performed a retrospective chart review for all patients who had undergone surgical excision of hidradenitis at a university hospital from 2012 to 2018. We identified 79 patients with a total of 220 operative sites. The majority were obese (mean body mass index [BMI] 32.5), female (71%), African-American (84%), and had a mean age of 31 years. A quarter of operative sites experienced a recurrence (n = 56). Patients who achieved remission had a significantly lower number of affected regions than those who experienced a recurrence (2.3 vs 3.6, P = .0023). Additionally, recurrence rate differed significantly between body locations (P = .0440). Smoking, BMI, Hurley grade, closure method, and excision size did not influence local cure rate. Surgical excision remains a worthy management option for hidradenitis patients with three quarters achieving remission after a single operation. Number of affected regions and location of hidradenitis may play a factor in recurrence.

Reconstruction for axillary hidradenitis suppurativa using one‐stage local tissue rearrangement: A retrospective analysis of 53 cases

“…While recurrence rates after surgical excision reported in the literature range from 6% to 47%, the recurrence rate in our study was low (10%). In our cohort, the median disease‐free interval for sites where a recurrence occurred was 5 months, which is similar to that of other studies . Although sufficient resection of diseased skin is the most important factor in preventing recurrence, more recent reports have suggested that the number of affected regions, location of hidradenitis, and type of surgical reconstruction may also play a role .…”

“…In our cohort, the median disease‐free interval for sites where a recurrence occurred was 5 months, which is similar to that of other studies . Although sufficient resection of diseased skin is the most important factor in preventing recurrence, more recent reports have suggested that the number of affected regions, location of hidradenitis, and type of surgical reconstruction may also play a role . Numerous methods for closure of axillary defects after wide local excision include primary complex closure, healing by secondary intention, STSG, and local flap rearrangement .…”

Wound Closure with Transcutaneous Absorbable Polyglactin Sutures after Hidradenitis Suppurativa Excision

“…However, this study is strengthened by its large sample size. Patient demographics were consistent with those found in the literature 14,24 and thus the results are considered representative of surgical patients with HS. Future studies comparing suture materials may provide additional information to guide standard of care.…”

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

“…Of the 37 articles that reported recurrence data after excision (representing 1840 patients), the recurrence rate was 30% ( n = 554 patients). Three studies reported recurrence by lesion number, with 98 of 371 lesions recurring across these studies (26.4%) [ 21 , 42 , 13 ]. One study reported recurrence by Hurley stage as follows: 3 lesions recurred in Hurley 1 patients (8.1%), 12 lesions recurred in Hurley 2 patients (32.4%), and 22 lesions recurred in Hurley 3 patients (59.5%) [ 21 ].…”