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Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest Dr Mostaghimi has received consulting or royalty fees from Pfizer, hims, Digital Diagnostics, Concert, Lilly, AbbVie, Equillium, Boehringer Ingelheim, LEO, and ACOM. Dr Charrow has received consulting fees from Novartis. Authors Ly, Manjaly, and Kamal and Dr Theodosakis have no conflicts of interest to declare.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Background: Adalimumab, the only biologic registered for hidradenitis suppurativa, shows clinical response in up to 60% of patients, leaving many patients in need for other treatment options such as surgery., Objective: To compare the clinical effectiveness of adalimumab combined with surgery vs adalimumab monotherapy in patients with moderate to severe hidradenitis suppurativa., Methods: A pragmatic Randomized Controlled Trial was performed from August 2018 to July 2022. Primary outcome was the difference in mean International Hidradenitis Suppurativa Severity Score System reduction after 12 months of treatment with the difference in mean Dermatology Life Quality Index reduction as a key secondary outcome., Results: Thirty-one patients were included per arm. The mean International Hidradenitis Suppurativa Severity Score System at baseline was 23.9 ± 10.7 in the surgery group and 20.9 ± 16.4, in the monotherapy group. After 12 months of treatment the surgery group had a significantly greater reduction in International Hidradenitis Suppurativa Severity Score System compared with the monotherapy group (-19.1 ± 11.3 vs -7.8 ± 11.8, P < .001). Moreover, the surgery group showed a greater reduction in Dermatology Life Quality Index after treatment compared with the monotherapy group (-8.2 ± 6.2 vs -4 ± 7.7, P = .02)., Limitations: The study follow-up was too short to assess surgical recurrence rates., Discussion: Combining adalimumab with surgery resulted in greater clinical effectiveness and improved quality of life after 12 months in patients with moderate to severe hidradenitis suppurativa., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Conflicts of interest None disclosed.

Background: Effective medical treatment for patients with severe hidradenitis suppurativa (HS) is limited., Objectives: We sought to measure the impact of wide local excision on quality of life in HS Hurley grade III patients and to examine the rate of postoperative complications, disease recurrences, and satisfaction with the cosmetic results., Methods: Seventy-four patients were enrolled. Outcome measures included Dermatology Life Quality Index responses, disease duration, recurrence, previous therapies, postoperative complications, and satisfaction with cosmetic results., Results: Most patients had inguinogenital/gluteal disease (68.9%, P < .001). Involvement of both the axillary and the inguinogenital/gluteal areas were pronounced in male patients (P = .018). None of the patients was treated with tumor necrosis factor-α inhibitors. Most patients (71.6%) had a disease history of >5 years at the time of presentation and multiple unsuccessful attempts with systemic and local therapeutic interventions. Wide local excision improved Dermatology Life Quality Index scores from initially 27.89 to 5.31 after surgery (P < .001), independent of localization (P = .195). Forty-seven percent of patients had postoperative complications, most frequently pain and scarring. The vast majority of patients (70.3%) were satisfied with the cosmetic results., Limitations: The retrospective nature of the study was a limitation., Conclusions: Wide local excision significantly improves the quality of life of HS patients. Local recurrence rates are low, and satisfaction with the cosmetic results is high., (Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Hidradenitis suppurativa is a debilitating inflammatory skin disease with a chronic course and often disappointing response to treatment. Though a minority of persons (20%) reports symptom remission during pregnancy, the vast majority experiences no relief (72%), and few experience clinical deterioration (8%). Disease flares are also observed post-partum. The pathophysiological basis for pregnancy-associated fluctuations in clinical status is currently unknown. Because most women with HS require ongoing management throughout pregnancy, it is important to evaluate the suitability and safety of current treatment options for pregnant women. The following review will outline current management strategies for HS and their compatibility with pregnancy and lactation., (Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

When the prevention of new lesions fails and when medical therapy of established and growing lesions is ineffective, surgery is the accepted method of dealing with hidradenitis suppurativa/acne inversa. The rationale and preferred techniques of mini-unroofing using a biopsy punch, deroofing using scissors, electrosurgery or laser, and classical wide excision and closure are discussed. The situation in which incision and drainage is considered for temporary pain relief would be best considered an opportunity for deroofing, as illustrated in the accompanying online videos., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Pyoderma gangrenosum, severe acne, and suppurative hidradenitis (PASH) syndrome can prove refractory to treatment and is characterized by relapses and recurrences. The combination of antibiotic therapy and surgery can produce success in the management of the syndrome. Acute treatment is required, but maintenance therapy is also necessary to prevent disease relapse. The response to antibiotic therapy is hypothesis generating, raising the issue of a modified host response. To date, anecdotal reports support the use of surgery and medical therapy, but controlled investigations with extended follow-up are necessary to substantiate preliminary data observed with individual cases., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates., Objective: This study provides a comprehensive systematic review of surgical approaches in the management of HS., Methods: A systematic literature search and meta-analysis of proportions were performed on the included studies., Results: Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing., Limitations: There was poor quality evidence and potential improper reporting of the results., Conclusion: This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that commonly develops painful, deep dermal abscesses and chronic, draining sinus tracts. Classically, pharmacologic and surgical therapies have been effective for reducing lesion activity and inflammation, but provide only modest success in the prevention of future recurrences and disease progression. Adjunctive therapies, such as laser and light-based therapies, have become more commonly used in the management of HS. These therapies work to reduce the occurrence of painful HS flare-ups by decreasing the number of hair follicles, sebaceous glands, and bacteria in affected areas, and by ablatively debulking chronic lesions. The best results are seen when treatment is individualized, taking disease severity into consideration when selecting specific energy-based approaches. This article will discuss various light-based therapies and the evidence supporting their use in the management of HS., (Copyright © 2015. Published by Elsevier Inc.)

Background: Recent prevalence estimates for hidradenitis suppurativa (HS), a chronic inflammatory skin condition, are limited by timeliness, population size, and generalizability., Objective: We sought to develop prevalence estimates for HS in the United States using large health care claims databases., Methods: A retrospective analysis used PharMetrics Integrated Database to gather health care claims information for HS among patients with 12 or more months of continuous enrollment in a commercial health care plan throughout 2007. Included patients had: 1 or more diagnoses with International Classification of Diseases, Ninth Revision, Clinical Modification code 705.83 for HS during 2007 without a Current Procedural Terminology code for HS; 1 or more Current Procedural Terminology codes of 11450, 11451, 11462, 11463, 11470, or 11471 during 2007 without International Classification of Diseases, Ninth Revision, Clinical Modification code 705.83; or both. Age- and gender-specific prevalence projections were calculated., Results: Among included patients (n = 7927), mean age (SD) was 38.2 (14.73) years, and 5834 (74%) were women. Most patients (n = 5205; 66%) were aged 30 to 64 years. The overall prevalence estimate was 0.053% (95% confidence interval 0.051-0.054). When adjusted for gender and age, prevalence rates were 0.052% and 0.051%, respectively. The most common procedures for HS were excision of skin and subcutaneous tissue axillary/inguinal simple or intermediate repair., Limitations: Limitations were a health insured-only population; 12-month enrollment period for 2007; HS-specific procedural codes; and possible HS misclassifications., Conclusion: We found a low rate of clinically detected HS (0.053%; approximately 146,000-162,000 patients in the United States in 2007), with affected persons almost 3 times as likely to be female and the highest prevalence in those aged 18 to 44 years., (Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, often refractory to treatment. Patients with HS and dermatologists are in need of an effective, fast surgical intervention technique. Deroofing is a tissue-saving technique, whereby the "roof" of an abscess, cyst, or sinus tract is electrosurgically removed. The use of a probe is mandatory to explore the full extent of a lesion., Objective: We sought to evaluate the efficacy and patient satisfaction of the deroofing technique for recurrent Hurley I (mild) or II (moderate) graded HS lesions at fixed locations., Methods: An open study consisted of 88 deroofed lesions in 44 consecutive patients with HS, treated by a single clinician with a follow-up time of up to 5 years., Results: Fifteen of 88 (17%) treated lesions showed a recurrence after a median of 4.6 months. In all, 73 treated lesions (83%) did not show a recurrence after a median follow-up of 34 months. The median patient satisfaction with the procedure rated 8 on a scale from 0 to 10. Of the treated patients, 90% would recommend the deroofing technique to other patients with HS. One side effect occurred in the form of postoperative bleeding., Limitations: Some patients were lost to follow-up., Conclusions: The deroofing technique is an effective, simple, minimally invasive, tissue-saving surgical intervention for the treatment of mild to moderate HS lesions at fixed locations and it is suitable as an office procedure., (Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the intertriginous areas., Objective: We sought to conduct clinical and histopathologic evaluation of the efficacy of long-pulsed neodymium:yttrium-aluminium-garnet laser treatment for HS., Methods: We conducted a prospective, randomized, right-left within-patient controlled trial for HS (n = 22). Four monthly laser sessions were performed. Disease activity was measured at baseline, and treatment response was assessed before each laser session and monthly for 2 months after the completion of laser treatment, using a modified scoring system based on Sartorius score. Histologic examination was performed at baseline, immediately after laser treatment, and at 1 and 4 weeks after treatment. A patient questionnaire was circulated on the last visit to assess patients' level of satisfaction., Results: There was progressive improvement in disease activity, most significantly during the 4 months of treatment, which was maintained during the 2-month posttreatment follow-up period. Averaged over all anatomic sites, the percent improvement was 72.7% on the laser treated side, and 22.9% on the control side (P < .05). Histologic examination showed an initial acute neutrophilic infiltrate. Granulomatous inflammation was present on follow-up biopsy specimens 4 weeks later. An inflammatory infiltrate surrounded the hair shaft remnants, denoting destruction of hair follicles., Limitations: Small sample size was a limitation., Conclusions: Long-pulsed neodymium:yttrium-aluminium-garnet laser, together with topical benzoyl peroxide and clindamycin, is significantly more effective than topical benzoyl peroxide and clindamycin alone for the treatment of HS. Preliminary review of histopathology suggests the mechanism of action is destruction of the hair follicle. The overall success of the treatment in both clearing pre-existing lesions and preventing new eruptions, coupled with high patient satisfaction, makes the neodymium:yttrium-aluminium-garnet laser a promising treatment advance for this highly disabling condition., (Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: The chronic fistulating lesions of hidradenitis suppurativa spread by contiguous growth, and all affected tissue needs to be surgically removed., Objective: The aim of our study was to evaluate a surgical method for treatment of Hurley stage II hidradenitis suppurativa (HS), the carbon dioxide laser rapid-beam optomechanical scanner system in continuous mode., Methods: Thirty-four patients were evaluated after treatment; 31 patients were women, and the mean age was 33.9 years (range, 15-55 years). All patients had had HS for a mean of 13.4 years (range 1-35 years) and more than 3 recurrences of suppurating lesions in the year before inclusion in the study. All lesions had been classified as Hurley stage II. The mean follow-up time after carbon dioxide laser surgery was 34.5 months (range, 7-87 months), and patients were later contacted by telephone about recurrences and the end results., Results: The mean healing time was about 4 weeks (range, 3-5 weeks). During follow-up, 4 of the 34 patients had recurrences at the surgical site, that is, locoregional HS. Thirty had no recurrences in the treated area, but in 12 cases de novo suppurating lesions, separated from the initial surgical site by >5 cm, developed. Twenty-five patients had flares of HS lesion(s) in an area other than the treated site. Eight had no recurrences., Conclusion: Macroscopically controlled tissue-selective carbon dioxide laser treatment of HS is a fast, efficient treatment and well accepted by the patients.

Background: Hidradenitis suppurativa is a disabling disease. Although medical management can at times control the disease, the treatment of choice is surgical excision. Surgical defects have been managed by second-intention healing, simple surgical closure, or complex surgical repairs., Objective: Our purpose was to determine the benefit of carbon dioxide laser excision with healing by second intention to treat lesions of hidradenitis suppurativa., Methods: We treated seven patients who had axillary and inguinoperineal hidradenitis suppurativa with carbon dioxide laser excision followed by second-intention healing. A total of 12 procedures were performed (five bilateral and two unilateral). Follow-up periods were 10 to 27 months., Results: After a healing time of 4 to 8 weeks, scars were flat and linear. Only one recurrence of hidradenitis suppurativa has been observed; this occurred along the margin of the surgical scar in a previously treated area. Some patients, however, had continued disease activity in untreated areas. All subjects were satisfied with the results of the procedure, and complications were minimal., Conclusion: Carbon dioxide laser excision with second-intention healing is safe and effective for hidradenitis suppurativa.