Hidradenitis Suppurativa: Our Experience with a Surgical Case Management Team

Garbayo-Salmons, Patricia; Romaní, Jorge; Fuente, C. Ferrer de la; Lloveras, A. Pallisera; López-Llunell, Cristina; Escayola, J. Prat

doi:10.1016/j.adengl.2019.12.009

Cited by 3 publications

(7 citation statements)

References 12 publications

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“…For unroofing, studies report recurrence rates from as low as 0.0%–27.0% 13–15 . Saylor et al 11 showed a pooled recurrence rate of 14.5% of patients who did not receive adjuvant medical therapy and 0.0% of patients who did receive concurrent medical therapy.…”

Section: Surgical Outcomes For Hidradenitis Suppurativa and The Gaps ...mentioning

confidence: 99%

“…For unroofing, studies show a range for complication rate from 0.0% to 7.2% 14,16 . Saylor et al showed a pooled complication rate of 12.5% (83 complications out of 666 treated lesions).…”

Section: Surgical Outcomes For Hidradenitis Suppurativa and The Gaps ...mentioning

confidence: 99%

“…17,18 As shown in the focused review by Saylor et al, 11 For unroofing, studies report recurrence rates from as low as 0.0%-27.0%. [13][14][15] Saylor et al 11 showed a pooled recurrence rate of 14.5% of patients who did not receive adjuvant medical therapy and 0.0% of patients who did receive concurrent medical therapy. In the aforementioned meta-analysis, unroofing had a recurrence rate of 27.0%.…”

Section: Recurrence Ratesmentioning

confidence: 99%

“…T A B L E 2 Recurrence and complication rates following surgical management of hidradenitis suppurativa Recurrence and complication rates for surgical management of hidradenitis suppurativa Recurrence rates (range) Complication rates (range) Unroofing 0.0%-21.7% 11,[13][14][15] 0.0%-7.2% 11,14,16 Local excision 0.0%-67.8% 11,17,18 0.0%-61.1% 11,[19][20][21] Wide excision 0.0%-43.0% 12,13,19,22,23 0.0%-87.0% 13,19,23,24 Laser (carbon dioxideablative) Finally, very little data exists on how anatomic location impacts recurrence. However, in their meta-analysis, Ovadja et al 12 noted that HS caudal to the umbilicus was noted to have worse outcomes.…”

Section: Recurrence Ratesmentioning

confidence: 99%

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Surgical management of hidradenitis suppurativa: A review of techniques, data, and future directions

Klufas

Saylor

2022

Dermatological Reviews

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Hidradenitis suppurativa (HS) is a debilitating, chronic dermatologic condition that when left untreated can lead to irreversible structural changes in the skin, often manifesting as subcutaneous tunnels, defined as linear tracts that may open onto the skin surface. While medical management may delay architectural damage to the skin, for those patients whose disease has progressed past the point of medical intervention and irreversible tissue damage is present, surgical treatment is a critical component in disease management. Various surgical treatment modalities such as unroofing and excision exist to treat HS surgically, however, the data regarding efficacy and surgical outcomes for these techniques is heterogeneously reported and often of low quality. As such, it is difficult to assess this data and determine what the best surgical option is for an individual patient. This manuscript will focus on categorizing the various types of surgical procedures used in the surgical and procedural management of HS, summarize data on outcomes measures of various treatment modalities, identify current gaps in the literature regarding HS surgery, and outline the necessary steps to address these gaps to standardize and improve the surgical care of all HS patients.

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Section: Surgical Outcomes For Hidradenitis Suppurativa and The Gaps ...mentioning

confidence: 99%

“…For unroofing, studies show a range for complication rate from 0.0% to 7.2% 14,16 . Saylor et al showed a pooled complication rate of 12.5% (83 complications out of 666 treated lesions).…”

Section: Surgical Outcomes For Hidradenitis Suppurativa and The Gaps ...mentioning

confidence: 99%

Section: Recurrence Ratesmentioning

confidence: 99%

Section: Recurrence Ratesmentioning

confidence: 99%

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Surgical management of hidradenitis suppurativa: A review of techniques, data, and future directions

Klufas

Saylor

2022

Dermatological Reviews

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“…In photodynamic therapy, three elements are needed: light, photosensitizing agent, and oxygen. The benefits of PDT in HS are probably based on the regulation of the local immune disturbance, a scarring effect, and an antimicrobial effect achieving the breakup of the biofilms 10‐13 …”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided photodynamic therapy with intralesional methylene blue and a 635 nm light‐emitting diode lamp in hidradenitis suppurativa: A retrospective study of 41 patients

Gamissans

Riera-Martí

Romaní

et al. 2021

Photoderm Photoimm Photomed

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Background Photodynamic therapy for hidradenitis suppurativa (HS) is a therapeutic alternative with a good safety profile, but its effectiveness has yet to be demonstrated. Objectives To demonstrate the effectiveness of PDT with intralesional methylene blue in HS lesions. Methods A retrospective cross‐sectional study was performed. Forty‐one patients were treated with intralesional methylene blue and a diode lamp. Follow‐up was carried out at 1 and 6 months after therapy. Efficacy was determined by the diameter reduction of the lesion measured by high‐frequency ultrasound. Results A reduction of ≥75% in the maximum diameter was recorded in 58.5% of the lesions, while 22% showed a reduction between 50% and 75%, and 19.5% showed a reduction of <50%. Recurrence rate was 12.5%. The lesions treated in patients with typical forms of HS (Canoui‐Poitrine phenotype I) had a better therapeutic response. No statistically significant differences were found in terms of lesion location or concomitant treatment. Conclusion This therapy may potentially be a cost‐effective and well‐tolerated local therapy for Hurley I‐II patients with superficial abscesses and fistulas.

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Psychiatric Influences on Hidradenitis Suppurativa: A Call for Help

Shan,

Huffman,

Bovill

et al. 2024

Arch Plast Surg

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Objective: Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. The study aim was to assess impact of a psychiatric diagnosis on patients treated for HS. Methods: Patients with HS were retrospectively identified at a single institution from 2010-2021. Cohorts were stratified by the presence of a psychiatric disorder. Demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the procedural interventions and emergency department (ED) visits. Financial distress was assessed via the COST-FACIT Version 2 survey. Results: Out of 138 patients, 40 (29.0%) completed the survey of which 19 (47.5%) had a pre-existing psychiatric diagnosis. No demographic differences were found between cohorts. Mean follow-up was 16.1+11.0 months. The psychiatric cohort had a higher median number of surgeries received (7.0 vs.1.5, p<0.001), a higher median number of ED visits (1.0 vs 0, p=0.006), and a similar hospital length of stay (p=0.456). The overall mean COST-FACIT score was 19.2+10.7 (grade one financial toxicity). The psych cohort had a lower mean COST-FACIT score (16.8 vs. 21.3, p=0.092) and reported greater financial hardship (3.3 vs. 1.7, p<0.001). On multivariate analysis a psychiatric diagnosis was predictive of lower credit scores, more ED visits, and a higher number of surgeries. Conclusion: Pre-existing psychiatric conditions in patients with HS are associated with increased healthcare utilization and surgical intervention with substantial financial distress. Plastic surgeons should be cognizant of such comorbid disorders to facilitate holistic care addressing all patient needs.

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Hidradenitis Suppurativa: Our Experience with a Surgical Case Management Team

Cited by 3 publications

References 12 publications

Surgical management of hidradenitis suppurativa: A review of techniques, data, and future directions

Surgical management of hidradenitis suppurativa: A review of techniques, data, and future directions

Ultrasound‐guided photodynamic therapy with intralesional methylene blue and a 635 nm light‐emitting diode lamp in hidradenitis suppurativa: A retrospective study of 41 patients

Psychiatric Influences on Hidradenitis Suppurativa: A Call for Help

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