Management of surgical therapy for advanced hidradenitis suppurativa with special consideration of perioperative antibiotic treatment - a questionnaire study

Abstract

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease, which affects areas of the body that bear apocrine glands. In extensive cases, a combination of surgical and antibiotic treatment is often needed. Studies are available on the effects of clindamycin, also in combination with rifampicin, or tetracyclines. However, there are few precise recommendations for the perioperative application of antibiotic agents. An anonymous survey was conducted to determine the current status quo of perioperative antibiotic treatment. Physicians and surgeons were surveyed who worked at a department for plastic surgery, general surgery or dermatology in the German-speaking area. The questionnaire itself was created with Limesurvey© and was sent out to qualified departments, with the help from federal ministries of health. The responses were statistically analysed with IBM® SPSS® version 23. In most cases, the antibiotic treatment started before surgical intervention. Bacterial swabs were the most important factor in the selection of antibiotic agents. Most of theparticipants adjusted the treatment to the microbiological results, regardless of the chosen moment of application. Clindamycin was the most often used topical and systemic agent. The combination with rifampicin was most common. Adalimumab was the most commonly used antibody against tumor necrosis factor-alpha (TNF-α). In nearly half of the cases, antibodies were combined with antibiotics, and then the duration of treatment was usually longer. The extent of the disease was the most important factor for the necessity of surgical interventions. The wide excision of the whole affected area with subsequent healing by secondary intention was the surgical method of choice in all but one area. This study has shown that there are significant differences in the treatment between disciplines and countries. On the one hand, the disease severity, on the other hand, individual experience and preferences affect the treatment. Depending on the discipline that determined the therapy, some treatments are provided more rarely or not at all. Revised and up-to-date guidelines embodying all relevant disciplines would be desirable for a standardised therapy.