394 The pivotal role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III) – retrospective analyses of 74 patients

Abstract

Hidradenitis suppurativa (HS) is a painful, chronic, recurrent inflammatory skin disease that affects terminal hair follicles and apocrine glands. It develops in early adolescence, and is confined to axillary and inguinogenital/gluteal regions. This study aimed to measure the impact of surgery on the individual quality of life in severe grade HS patients. Additionally, parameters such as disease duration, previous therapeutic interventions, postoperative complications (pain, infection, scarring, wound healing deficiency, mobility restrictions), postoperative recurrence and satisfaction with the cosmetic results were collected. Data from 74 patients (40 male, 34 female) with HS Hurley grad III treated with wide local excision and secondary wound healing were evaluated. Most patients had inguinogenital/gluteal disease (n=51, 68.9%, p<0,001). Inguinogenital/gluteal disease was pronounced in female patients (p=0.009). Involvement of both, axillary and inguinogenital/gluteal areas were pronounced in male patients (p=0.018). Most patients (n=53; 71.6%) had a disease history of more than 5 years at the time of initial presentation at our institution. Wide local excision improved the Dermatology Life Quality Index (DLQI) scores from initially 27.89 (range 2-30; SD=5.3) to 5.31 (range 0-26; SD 7.38; p<0.001) independent of localization (p=0.195). 47.3% of patients had postoperative complications, most frequently pain and scarring. Local recurrence rates were calculated with 18.9% from follow-up data covering a period of up to 14 years. 70.3% of patients were highly satisfied with the cosmetic results. From our study we conclude that wide local excision of affected skin significantly improves the quality of life of HS Hurley grad III patients. Further, surgery has the potential to locally heal HS areas with high satisfaction with the cosmetic results. The socio-economic footprint of wide local excision, to date, favors surgery over systemic therapies with anti-inflammatory biologics.