Guidelines hidradenitis suppurativa
Updated on Aug 19
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The use of this data is under the sole responsibility of the user. The Société Française de Dermatologie cannot be blamed for a misinterpretation of the data provided by the site, or in the event of erroneous information. This decision tree and all the contents of this site have been developed in the context of updated data from science according to the HAS methodology, expert opinions and reviewers of the various documents and in the context of the French healthcare system.
Surgery is to be considered systematically within a medical and surgical concertation meeting.
Surgery can be chosen depending on clinical presentation, as an urgent measure for abscesses, or can be scheduled in other cases.
For a fluctuant abscessed nodule: urgent incision and drainage or deroofing with a biopsy punch are indicated for immediate pain relief. This is not a definitive treatment and relapses are frequent.
For a Hurley stage Ⅰ persistent cold nodule, or Hurley stage Ⅱ sinus tracts (tunnels, fistula), the following can be envisaged:
complete excision limited to the lesion, with or without direct suture. Relapse rates vary from 40 % to 70 %;
tangential excision
or marsupialization (deroofing) with ablation of the lesion: this makes it possible to preserve healthy skin; this can be followed up with controlled wound healing. Relapse rates vary by study from 20 % to 50 %.
deroofing
These types of excision are most often performed under local anaesthesia, tumescent if necessary, and can therefore be performed by dermatologist expert in dermatological surgery.
For a scar mass, Hurley stage Ⅱ bands or particular stage Ⅲ bands, a wide excision under general anaesthesia is suggested: a wide (1-3 cm) and deep safety margin of healthy skin is recommended. Loss of substance should not be reduced to facilitate reconstruction.
wide excision
Surgical incision performing away from nodular lesions and sinuous tracts (Hurley stages Ⅱ and Ⅲ) with deep safety margin in healthy skin space for complete removal.
Direct suturing is generally impossible and the wound must be closed either by controlled healing or by thin or flap skin graft. Wide excision has better therapeutic results, with the lowest rate of relapse in the area treated (0-15 %). It involves prolonged local post-operative care. In the long term, there is a risk of retractile scars (in particular axillary contractures, vulva widening, stenosis or anal incontinence) which should be anticipated by posturing and physiotherapy.
Videos
Armpit fistulas deroofing
Source: Dr O. Cogrel, Service de Dermatologie du CHU de Bordeaux
Vulvar fistulas deroofing
Source: Dr O. Cogrel, Service de Dermatologie du CHU de Bordeaux
Laser CO₂ deroofing
Source: Dr O. Cogrel, Service de Dermatologie du CHU de Bordeaux
Large excision thin skin graft
Source: Dr O. Cogrel, Service de Dermatologie du CHU de Bordeaux
Result
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