Hidradenitis suppurativa treated with wide excision and
second intention healing: a meaningful local cure rate after
I.E. Deckers, Y. Dahi, H.H. van der Zee, E.P. Prens*
Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
*Correspondence: E.P. Prens. E-mail: firstname.lastname@example.org
Background Surgery is an important treatment modality for hidradenitis suppurativa (HS). Various methods of HS sur-
gery have been described. Even though wide excision is a common surgical procedure for HS, data on the recurrence
rate and patient satisfaction are scarce.
Objective To determine the recurrence rate and patient satisfaction of HS lesional wide excision (complete excision)
with secondary intention healing.
Methods A single centre retrospective study. Hundred and twenty eligible patients were identiﬁed from our medical
ﬁles, and an individualized questionnaire was sent.
Results Eighty-six patents responded to our questionnaire (71.7%). Of whom, 84 patients underwent in total 253 pro-
cedures. The mean follow-up time per procedure was 36.2 months. In 37.6% of the procedures, recurrence occurred
within a mean follow-up period of 3 years (after a median of 6.0 months). Total remission of an anatomical area was
achieved in 49% of the procedures, whereas natural disease progression occurred in 13%. The genital region was the
most prone to recurrence. The majority of the patients were glad that they had undergone the procedure and would
recommend the surgical procedure to other HS patients.
Conclusion Lesional wide excision (complete excision) with secondary intention healing yields a meaningful local cure
rate for HS and is well tolerated.
Received: 15 August 2017; Accepted: 7 December 2017
Conﬂicts of interest
Hidradenitis suppurativa (HS) is a chronic inﬂammatory skin
disease, characterized by painful deep-seated nodules and
abscesses mainly located in the inverse body areas.
ment of HS is usually a combination of medical treatment and
surgery. Patients are generally treated with several courses of
antibiotics, or in more severe cases, with tumour necrosis factor
alpha (TNF-a) inhibitors.
However, wide excision surgery pro-
vides the best chance for remission in HS.
The most common
surgical procedures are incision with drainage, derooﬁng, and
limited or wide excision. Incision with drainage is usually per-
formed in acute stages to drain pus from abscesses and to relieve
pain, but recurrence rates up to a 100% have been reported.
Derooﬁng is a surgical technique whereby the lesions are
explored using a probe and the roof is excised; it is most effective
for recurrent lesions in a mild phase of the disease.
also be totally excised using limited excision or wide excision
surgery, in which smaller margins tend to have a higher recur-
rence rate than wider excisions.
Even though wide excision is
a common surgical procedure for HS, studies in large cohorts of
HS patients on the recurrence rate and patient satisfaction are
scarce. We therefore retrospectively studied the recurrence rate
and patient satisfaction of HS patients who had undergone wide
surgical excision under general anaesthesia, with healing by sec-
Patients and methods
We identiﬁed all patients with HS who underwent wide excision
under general anaesthesia between 2007 and 2014, in the Depart-
ment of Dermatology of the Erasmus University Medical Center
© 2017 European Academy of Dermatology and Venereology
2018, 32, 459–462