Deroofing Shows Promise for HS Patients: Effective, Low Recurrence, and Improved Quality of Life

June 18, 2025

Authors:

Robyn Guo, Third-Year Medical Student, Duke University School of Medicine
Natalie M. Fragoso, MD, Dartmouth Hitchcock Medical Center, Department of Dermatology

Why Was This Research Done?

Deroofing is a surgical procedure where the “roof" of a hidradenitis suppurativa (HS) lesion and accompanying sinus tracts are removed. This study was conducted to look at the efficacy and safety of deroofing in the management of new and old HS lesions in patients with mild, moderate, and severe disease. This study also looked at how deroofing impacts pain control and quality of life.

How Was This Research Done?

This study followed 44 patients with HS who underwent deroofing between December 2019 and December 2021. Of the 44 patients, 11% had mild HS, 70% had moderate HS, and 18% had severe HS. Almost half were on a systemic therapy like adalimumab or infliximab. A total of 115 HS lesions were deroofed, of which 80% were over six weeks old. Patients attended follow-up appointments at 3 and 12 months after undergoing deroofing. At these follow-up visits, researchers assessed whether any side effects had occurred and if the deroofed lesions had returned. They also evaluated changes in patients' pain levels and quality of life before and after the procedure.

What Did The Study Find?

1. At the 3-month follow-up, 10% of the 115 deroofed HS lesions had recurred, increasing slightly to 12% by the 12-month mark.
2. Patients with severe HS were more likely to have their lesions come back after deroofing compared to patients with mild and moderate HS.
3. Deroofing reduced patient pain scores and improved quality of life.
4. After deroofing, 89% of patients reported that their skin took more than two weeks to heal. Only 2% experienced an infection at the surgery site, and 18% required prescription pain medications while healing.
5. Most patients were satisfied with their deroofing procedure and would undergo deroofing again.

What Is The Impact Of These Results?

This study suggests that deroofing is a safe and effective procedure for patients with HS and has few side effects. At 12 months after deroofing, only 12% of the deroofed HS lesions came back. Patients found that deroofing improved their pain and quality of life and most of them said they would undergo another deroofing procedure. One drawback to this study is that all procedures were performed at the same institution. More studies with a larger number of patients are needed to support the finding that deroofing is a safe and effective procedure.

Paper citation: Vu TT, Soong LC, Hagtvedt R, Keeling CP. Surgical Deroofing in the Management of Hidradenitis Suppurativa Alone or as an Adjunct to Medical Therapies. Dermatol Surg. 2025 Mar 17. doi: 10.1097/DSS.0000000000004604. Epub ahead of print. PMID: 40094294.

Image credit: https://unsplash.com/photos/closeup-of-medical-equipment-dW4JdHifUmI