Challenging treatment of hidradenitis suppurativa with happy ending


  • Murat Akici Department of General Surgery, The Faculty of Medicine, Afyonkarahisar Health Science University, Afyon, Turkey
  • Murat Cilekar Department of General Surgery, The Faculty of Medicine, Afyonkarahisar Health Science University, Afyon, Turkey



Total excision, Stoma, Hidradenitis suppurativa, Flap


Background: Hydradenitis supurativa (HS) is a chronic, recurrent and inflammatory disease which involves skin and subcutaneous fatty tissue. The aim of this study was to retrospectively evaluate the treatment results of 12 patients who were diagnosed as hidradenitis suppurativa with local or multiple site involvements in our clinic.

Methods: Data of 12 patients with local or multiple site involvement, who had hidradenitis suppurativa surgery between January 2013 and January 2018 were evaluated retrospectively.

Results: Twelve patients, who were male, were included in the study. The average age was 39.4 (25-56) years old. A total of 5 patients were with local and 7 patients were with multiple region involvements. 8 patients had axillary, 3 patients had genitalia, 4 patients had perianal and 7 patients had sacral region involvements. Two of 4 patients with perianal region had protective stomas. In total, 16 surgical procedures were performed to the patients. In 6 patients, some parts of wounds were primary closed and followed-up with secondary healing. Skin grafting was performed for the four of these patients in late period. In 4 patients, defects were closed with primary closure and with rotation flaps in 2 patients. No recurrence was observed among the patients. The average duration of follow-up was 32.5 months.

Conclusions: The surgical treatment process of hidradenitis suppurativa, which is a chronic disease, is not more difficult and longer than its natural course. In recent years, complete recovery can be achieved with current surgical methods.


Shah N. Hidradenitis Suppurativa: A Treatment Challenge. Am Fam Physician. 2005;72:1547-52.

Kagan RJ, Yakuboff KP, Warner P, Warden GD. Surgical treatment of hidradenitis suppurativa: a 10-year experience. Surgery. 2005;138:734-41.

Soldin MG, Tulley P, Kaplan H, Hudson DA, Grobbelaar AO. Chronic axillary hidradenitis--the efficacy of wide excision and flap coverage. Br J Plast Surg. 2000;53:434-6.

Von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389-92.

Hoffman LK, Ghias MH, Lowes MA. Pathophysiology of hidradenitis suppurativa Semin Cutan Med Surg. 2017;36(2):47-54.

Patel ZS, Hoffman LK, Buse DC, Grinberg AS, Afifi L, Cohen SR, et al. Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa [corrected]. Curr Pain Headache Rep. 2017;21(12):49.

Balık E, Eren T, Yamaner S, Bulut T, Buğra D, Büyükuncu Y, et al. Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal / Peri-anal and Gluteal Regions Kolon Rektum Hast Derg. 2007;17:27-32.

Gener G, Canoui-Poitrine F, Revuz JE, Faye O, Poli F, Gabison G, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology. 2009;219:148-54.

Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: An update. J Am Acad Dermatol. 2015;73(5):8-11.

Farrel AM, Randall VA, Vafaee T, Dawber RPR. Finasteride as a therapy for hidradenitis suppurativa. Br J Dermatol. 1999;141:1138-9.

Fearfield LA, Staughton CD. Severe vulval apocrine acne successfully treated with prednisolone and isotretinoin. Clin Dermatol. 1999;24:189-92.

Jemec GBE. Methotrexate is of limited value in the treatment of hidradenitis suppurativa. Clin Exp Dermatol. 2002;27:528-9.

Bocchini SF, Habr-Gama A, Kiss DR, Imperiale AR, Araujo SE. Gluteal and perianal hidradenitis suppurativa: surgical treatment by wide excision. Dis Colon Rectum. 2003;46:944-9.

Slade DEM, Powell BW, Mortimer PS. Hidradenitis suppurativa:pathogenesis and management. Br J Plast Surg. 2003;56:451-61.

Tüzün Y, Arzuhal N. Hidradenitis süpürativa tedavisi. Dermatose. 2007;2:185-90.

Saunte DML, Jemec GBE. Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA. 2017;318(20):2019-32.

Wiseman MC. Hidradenitis Suppurativa: a review. Dermatol Ther. 2004;17:50-4.

Mitchel KM, Beck DE. Hidradenitis Suppurativa. Surg Clin N Am. 2002;82:1187-97.

Brown SC, Kazzazi N, Lord PH. Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form. Br J Surg. 1986;73:978-80.

Attanoos RL, Appleton MAC, Dougles-Jones AG. The pathogenesis of hidradenitis suppurativa : a closer look at apocrine and apoeccrine glands. Br J Dermatol. 1995;133:254-8.

Yu CCW, Cook MG. Hidradenitis Suppurativa: disease of follicular epithelium, rather than apocrine glands. Br J Dermatol. 1990;12:763-9.

Alhusayen R, Shear NH. Pharmacologic interventions for hidradenitis suppurativa: what does the evidence say? Am J Clin Dermatol. 2012;13(5):283-91.

Maarouf M, Clark AK, Lee DE, Shi VY. Targeted treatments for hidradenitis suppurativa: a review of the current literature and ongoing clinical trials. J Dermatolog Treat. 2018;29(5):441-9.

Grischkan D, Steiger E, Fazio V. Maintenance of home hyperalimentation in patients with high-output jejunostomies. Arch Surg. 1979;114:838-41.

Diseth TH, Emblem R. Somatic function, mental health, and psychosocial adjustment of adolescents with anorectal anomalies. J Pediatr Surg. 1996;31:638-43.






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