AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

AAD 2024 Hidradenitis Suppurativa Symposium: Office-Based Surgical Procedures for HS

Description

The presentation at the AAD 2024 Hidradenitis Suppurativa Symposium focused on office-based surgical procedures for managing Hidradenitis Suppurativa (HS), emphasizing that although HS was once viewed as strictly a surgical disease, its treatment has evolved significantly with advancements in medical management. The speaker outlined that all stages of HS could benefit from procedural interventions, particularly highlighting the de roofing technique, which involves removing the overlying skin of HS cavities while leaving the base intact, resulting in lower recurrence rates compared to traditional incision and drainage. Preoperative patient optimization, thorough physical examinations, and detailed patient education about expectations and the social impacts of HS were described as critical components of the management process. The speaker also covered the use of lasers, particularly for hair removal to prevent follicular occlusion associated with HS, and discussed the efficacy of botulinum toxin treatments for symptom relief, noting their positive impact on patients' quality of life. Overall, the procedures discussed provide practitioners with practical tools to address HS effectively in an outpatient setting, improving patient outcomes.

View more

Conclusions

  • Surgery's role in Hidradenitis Suppurativa (HS) has evolved due to advances in medical management, yet it remains applicable for all stages of the disease.
  • Deroofing is a commonly utilized procedure that effectively removes significant skin overlying HS cavities with low recurrence and complication rates.
  • High patient satisfaction is reported with deroofing, as most patients would recommend the procedure and choose to undergo it again.
  • Proper patient education and preoperative planning, including medical optimization, are crucial for successful outcomes in HS surgical procedures.
  • Office-based interventions such as laser hair removal and botulinum toxin use are valid options that can complement the management of HS.
  • Laser treatments demonstrate efficacy in reducing disease metrics, with the long-pulsed Nd:YAG laser being especially beneficial for patients with darker skin types.
  • Botulinum toxin can improve quality of life in HS patients, likely through its effects on sweat gland activity and inflammation.
  • Wound management post-deroofing emphasizes the importance of secondary intent healing to promote favorable cosmetic outcomes without activity restrictions.
  • Greeley PW. Surgical treatment of chronic suppurative hidradenitis. Arch Surg Chic III 1920. 1950;61(2):193-198.
  • Brownstone N, Saylor D. Office-Based Surgical Treatment of Hidradenitis Suppurativa: The Unroofing Technique. J Am Acad Dermatol. Published online November 19, 2020.
  • Bui H, et al. Surgical Procedural Definitions for Hidradenitis Suppurativa Developed by Expert Delphi Consensus. JAMA Dermatol. 2023 Feb 22.
  • Ayala D, Dhanasekara CS, Thomas K, et al. Surgical management of advanced hidradenitis suppurativa via a one-stage procedure: A single-center experience. Am J Surg. 2020;220(6):1462-1466.
  • Saylor DK, Brownstone ND, Naik HB. Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists. Dermatol Ther. 2020;10(4):529-549. doi:10.1007/s13555-020-00391-x
  • Ravi S, Miles JA, Steele C, Christiansen MK, Sayed CJ. Patient Impressions and Outcomes After Clinic-Based Hidradenitis Suppurativa Surgery. JAMA Dermatol. 2022;158(2):132-141. doi:10.1001/jamadermatol.2021.4741.
  • Dzuali, F., Yaghi, M. & Saylor, D.K. Deroofing: A Practical Guide for the Dermatologist. Curr Derm Rep 13, 1-7 (2024). https://doi.org/10.1007/s13671-024-00419-x
  • Mansour MR, Rehman RA, Daveluy S. Punch debridement (mini-deroofing): An in-office surgical option for hidradenitis suppurativa. J Am Acad Dermatol. 2024 Jan 9:S0190-9622(24)00054-9. doi: 10.1016/j.jaad.2023.12.050. Epub ahead of print. PMID: 38211709.
  • Vilarrasa E, Camiña-Conforto G, Cabo F, Fernandez-Vela J, Pousa M, Romaní J. Drainage setons for the management of sinus tracts in hidradenitis suppurativa. J Am Acad Dermatol. 2023 Aug 26:50190-9622(23)02639-7.
  • Bolognia, Jean, L. et al. Dermatology. Available from: Elsevier eBooks+, (4th Edition). Elsevier - OHCE, 2017.
  • Robinson, June, K. et al. Surgery of the Skin E-Book. Available from: Elsevier eBooks+, (4th Edition). Elsevier - OHCE, 2017.
  • Grimstad Ø et al. Evaluation of medical and surgical treatments for hidradenitis suppurativa using real-life data from the Scandinavian registry (HISREG). J Eur Acad Dermatol Venereol. 2019 Jun;33(6):1164-1171.
  • John H, Manoloudakis N, Stephen Sinclair J. A systematic review of the use of lasers for the treatment of hidradenitis suppurativa. J Plast Reconstr Aesthet Surg. 2016 Oct;69(10):1374-81.
  • Qu H, Gao L. Botulinum toxin type A for the management of hidradenitis suppurativa. Am J Transl Res. 2021 Dec 15;13(12):14115-14120.
  • Grimstad Ø, Kvammen BØ, Swartling C. Botulinum Toxin Type B for Hidradenitis Suppurativa: A Randomised, Double-Blind, Placebo-Controlled Pilot Study. Am J Clin Dermatol. 2020 Oct;21(5):741-748.
  • Ravi M, Trinidad J. Botulinum Toxin in Hidradenitis Suppurativa: A Systematic Review. J Drugs Dermatol. 2022 Apr 1;21(4):408-412.
  • Lyons AB, Townsend SM, Turk D, Narla S, Baah N, Hamzavi IH. Laser and Light-Based Treatment Modalities for the Management of Hidradenitis Suppurativa. Am J Clin Dermatol. 2020 Apr;21(2):237-243.
  • Quiñonez RL, Agbai ON, Burgess CM, Taylor SC. An update on cosmetic procedures in people of color. Part 2: Neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction. J Am Acad Dermatol. 2022 Apr;86(4):729-739. PMID: 35189253.
  • Molinelli E, Sapigni C, Simonetti O, Brisigotti V, Giuliodori K, Offidani A. Alexandrite laser as an adjuvant therapy in the management of mild to moderate hidradenitis suppurativa: A controlled prospective clinical study. J Am Acad Dermatol. 2022 Sep;87(3):674-675.
  • Fradet M, Bulai Livideanu C, Katoulis A, Hegazy S, Bouznad A, Jendoubi F, Carlet C, Paul C, Konstantinou MP. Efficacy and tolerability of long-pulse Alexandrite laser hair removal for hidradenitis suppurativa. Eur J Dermatol. 2021 Jun 8.