Background:
Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin follicular disease that often manifests after puberty with painful deep-seated nodules, and tract forming abscesses in apocrine gland-bearing areas of the body. The sites commonly involved include axillary, inguinal and anogenital regions. HS has a dramatic decrease in quality of life in sufferers due to emotional, physical, and psychological consequences.(1)
Current treatment modalities for HS include lifestyle changes, topical agents (e.g. topical antibiotics), systemic agents (e.g. immunomodulating drugs), laser therapy, and surgery. Surgical management of HS ranges from excision direct closure or skin grafting, to deroofing and allowing to heal by secondary intention.(1-3)
Case presentation:
A 34-year-old male with hurley stage II HS underwent a wide local excision (WLE) and split thickness skin graft (STSG) to his left axilla in 2013, then deroofing and healing by secondary intention to his right axilla in 2021. He provided detailed insight into pain score, analgesia requirement, post operative wound care, complications, range of motion, healing time, and time to return to work. Overall, he preferred deroofing due to reduced post-operative pain score from 1-week, self-managed wound care, faster return to full range of motion and return to work, and overall faster self-reported healing time.
Conclusion:
This case study demonstrates a unique situation whereby the patient was able to provide insight into the patient experience of two surgical treatment methods for HS in his bilateral axillae. Further comprehensive studies comparing surgical treatment for HS is required to inform standard of care guidelines.