Hidradenitis suppurativa treated with wide excision and second intention healing: a meaningful local cure rate after 253 procedures.

BACKGROUND: Surgery is an important treatment modality for hidradenitis suppurativa (HS). Various methods of HS surgery have been described. Even though wide excision is a common surgical procedure for HS, data on the recurrence rate and patient satisfaction are scarce. OBJECTIVE: To determine the recurrence rate and patient satisfaction of HS lesional wide excision (complete excision) with secondary intention healing. METHODS: A single centre retrospective study. Hundred and twenty eligible patients were identified from our medical files, and an individualized questionnaire was sent. RESULTS: Eighty-six patents responded to our questionnaire (71.7%). Of whom, 84 patients underwent in total 253 procedures. The mean follow-up time per procedure was 36.2 months. In 37.6% of the procedures, recurrence occurred within a mean follow-up period of 3 years (after a median of 6.0 months). Total remission of an anatomical area was achieved in 49% of the procedures, whereas natural disease progression occurred in 13%. The genital region was the most prone to recurrence. The majority of the patients were glad that they had undergone the procedure and would recommend the surgical procedure to other HS patients. CONCLUSION: Lesional wide excision (complete excision) with secondary intention healing yields a meaningful local cure rate for HS and is well tolerated.

Sexual health and quality of life are impaired in hidradenitis suppurativa: a multicentre cross-sectional study.

BACKGROUND: Hidradenitis suppurativa (HS) has a major impact on patients' quality of life (QoL). Although it has commonly been assumed that HS impairs sexual health, only a single case-control study has been performed on sexual functioning in a small group of patients with HS. OBJECTIVES: To investigate the QoL with a particular focus on sexual health in a substantial population of patients with HS. METHODS: In total 916 patients with HS received an invitation to participate in this multicentre cross-sectional survey. RESULTS: Three hundred patients completed the questionnaires. This study showed a diminished QoL and sexual health in patients with HS (Female Sexual Function Index: 21·6 ± 9·6, International Index of Erectile Function: 49·7 ± 20·7, Arizona Sexual Experience Scale: 16·7 ± 5·3, Dermatology Life Quality Index: 12·5 ± 7·5). Sexual health was associated with QoL in women but not in men. Female sex and late onset of HS were associated with poor sexual function. Impairment of QoL was associated with anogenital involvement, early onset of HS, disease severity and disease activity. CONCLUSIONS: HS is associated with impaired sexual health and QoL. Physicians should not hesitate to ask patients with HS about their sexual function and, when needed, offer them psychological support.

Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study.

BACKGROUND: Hidradenitis suppurativa (HS) causes considerable morbidity. The long-term prognosis is of obvious interest to both patients and physicians. We conducted this study to determine the prognosis and risk factors in patients diagnosed with HS. OBJECTIVES: To describe the long-term prognosis and the clinical course of HS and its association to known risk factors. METHODS: A postal follow-up survey with uncomplicated factual questions was conducted. As all of the patients were well acquainted with their long-standing disease, this was thought to be sufficient for meaningful results. All cases were diagnosed by a dermatologist. Overall, 212 patients diagnosed with HS between 1981 and 2001 were studied after a median follow-up period of 22 years (range 12-32). RESULTS: The overall response rate was 71.2%, with 60.8% (129/212) valid (fully completed) questionnaires. Remission was reported by 39.4% (50/127) and improvement by 31.5% (40/127). Unchanged severity was reported by 20.5% (26/127), and 8.7% (11/127) experienced worsening disease. Tobacco smoking was reported by 92.2% (119/129). Among nonsmokers, 40% (35/88) reported remission vs. 29% (17/59) of active smokers. A higher proportion of nonobese patients (45%) reported remission than obese patients (23%). CONCLUSIONS: We found that 39.4% of the sample reported remission of HS. Suspected risk factors appeared to influence the prognosis. Smoking and obesity were significantly linked to a lower rate of self-reported remission. The notion that lifestyle factors play a role in HS appears to be supported by this survey.

An Update on Medical Treatment Options for Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission.