Surgical Management of Severe Hidradenitis Suppurativa in Women: Outcome and Quality of Life Assessment

Dana Sawan,Cyril Touboul,Barbara Hersant,Jean Paul Meningaud

doi:10.4236/ojog.2021.1111132

Abstract

Background: Hidradenitis suppurativa (HS) or Acne inversa sometimes referred to as Verneuil’s disease, is a rare and debilitating condition arising in the intertriginous folds that bear apocrine glands (axillae, groin, perineum, pubis, ano-genital area). It has a deleterious impact on the life of affected persons who tend to be more depressive and poorly socially and sexually connected because of pain, malodor and stigmatization. Methods: We conducted a retrospective study in Henri Mondor Hospital in Créteil, France, in order to assess the effectiveness of surgery as a radical treatment and also assess the factors related to recurrence and the surgical and sexual satisfaction in women operated for severe HS of perineum and genitalia. Results: Fifty-five women were included. We got a recurrence rate of 23.6%. 66.7% of recurrence occurred after localized excision. 83% of patients were satisfied with surgery results and would undergo a revision surgery or recommend it. The factors significantly associated with recurrence were overweight (p = 0.0046), location in groin (p = 0.0040), localized excision (p = 0.02), total excision (p = 0.009), healing via secondary intention (p = 0.001) and disability due to HS (p = 0.006). Assessment of sexual response thanks to the FSFI showed an alteration of all the domains of sexual response but the composite index of 18.51 was below the threshold to diagnose pathologic sexual condition.

Highlights

We conducted a retrospective study in Henri Mondor Hospital in Créteil, France, in order to assess the effectiveness of surgery as a radical treatment and assess the factors related to recurrence and the surgical and sexual satisfaction in women operated for severe Hidradenitis suppurativa (HS) of perineum and genitalia
We recorded a 49.1% rate of recurrence associated with overweight, location on groin, localized excision, total excision, healing via secondary intention and disability due to HS. 83% of the patients were satisfied with the surgery and would recommend it or accept revision surgery while the post-surgery composite index for sexual satisfaction was 18.51 meaning no pathologic sexual disorder
We retrospectively reviewed the files of 55 women with severe HS operated between December 2017 and June 2019

Summary

Introduction

It is in 1939 that the relation with apocrine glands was described by Brunstig [1] [2] It is a chronic and recurrent condition arising in apocrine gland bearing skin in the body folds, especially the groin and the armpit, causing painful abscesses and scarring. Hidradenitis suppurativa (HS) or Acne inversa sometimes referred to as Verneuil’s disease, is a rare and debilitating condition arising in the intertriginous folds that bear apocrine glands (axillae, groin, perineum, pubis, ano-genital area). It has a deleterious impact on the life of affected persons who tend to be more depressive and poorly socially and sexually connected because of pain, malodor and stigmatization. Assessment of sexual response thanks to the FSFI showed an alteration of all the domains of sexual response but the composite index of 18.51 was below the threshold to diagnose pathologic sexual condition

Methods

Results

Discussion

Conclusion