Experience with different treatment modules in hidradenitis suppuritiva: A study of 106 cases

Background: Hidradenitis suppuritiva, a disease of the apocrine sweat glands, has always been a challenging area to the plastic and reconstructive surgeon. The aetiology is idiopathic and medical treatment offers temporary relief only. Radical surgical excision, therefore, is the mainstay of active management. Aim: To present and evaluate a series of 106 patients of hidradenitis suppuritiva treated in the regional plastic surgery unit of southeast Scotland between January 1990 and December 2000. Patients: Median age at onset was 36 years (range 17-70 years). The patients were predominantly females (88.78%) and heavy smokers (98.1%). Median age before active surgical intervention was six years (range 1-30 years). The patients were divided into a mild group (n=64) and a severe group (n=42). All patients had broad-spectrum antibiotics and multiple incision and drainage procedures before referral from general practitioners, dermatologists or general surgeons. One hundred sites were managed by primary closure (mostly in the 'mild' group); 29 resurfaced with split skin grafts and 14 with local, fasciocutaneous or musculocutaneous flaps (mostly in the 'severe' group). Median postoperative follow-up period was three years (range 1-7 years). Results: In the 'primary closure' series, recurrence rate requiring at least one secondary operation was 69.88%. There was no recurrence, no serious complications and no revision operations in the 'graft' and the 'flap' series. Conclusion: A high index of suspicion is required before contemplating primary closure in hidradenitis suppuritiva, even in the 'mild' variety. This condition should always be treated aggressively by radical excision of all hair-bearing areas and reconstructed with a graft or a flap