Severe hidradenitis suppurativa (Hurley III) with axillary, inguinal, gluteal and perianal involvement: undermining surgery and surgical deroofing as adequate approach
Medical Review (Med. pregled), 2023, 59(2), 56-63.
G. Tchernev1,2, I. Lozev3, S. Kordeva1, J. C. Cardoso4, I. Pidakev3
1 Onkoderma – Clinic for Dermatology, Venereology and Dermatologic Surgery – Sofia
2 Department of Dermatology and Venereology, Medical Institute of Ministry of Interior – Sofia
3 Department of Common, Abdominal and Vascular Surgery, Medical Institute of Ministry of Interior – Sofia
4 Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
Abstract. Hidradenitis suppurativa (HS), also called acne inversa or “smoker’s boils” disease, is a multifactorial chronic inflammatory skin condition, affecting the daily life of the patients, which often leads to a poor quality of life and depression. Associated risk factors, such as nicotine use, obesity, stress and genetic predisposition, are widely known for its negative effect on the outcome. Acne inversa is often misdiagnosed and clinicians should be aware of the typical clinical findings as it can camouflage as other well-known diseases. Because of the challenging location and the severe pain accompanying the disease, clinicians often struggle to provide the most adequate therapy for each patient needs, which often results in relapses and worsening of the clinical condition. We present a case, in which a 36-year-old male patient, with severe Hurley Stage 3, was treated with topical and systemic medications including ertapenem, ceftriaxone, metronidazole, with little to no improvement, followed by multiple relapses of the condition, then successfully managed surgically. The most common used therapeutic options, including different types of medications, lifestyle changes and surgical approach, are discussed. Surgical approach, as the most suitable option for a better patient outcome regarding the stage of the disease, is discussed.
Key words: hidradenitis suppurativa, acne inversa, adalimumab, antibiotics, surgery, deroofing
Address for correspondence: Prof. Dr Georgi Tchernev, e-mail: georgi_tchernev@yahoo.de