Surgical management of seasonal flares in hidradenitis suppurativa

January 1, 2024

This plain-language research summary was generated by AI, courtesy of HS Simplified.

AI Generated Content Verified By: Harib Ezaldein, MD, FAAD, FACMS | Miami Dermatology & Mohs Surgery

Surgical management of seasonal flares in hidradenitis suppurativa

In 2024, researchers highlighted the seasonal spikes in emergency visits for hidradenitis suppurativa (HS), a chronic skin condition leading to painful, inflamed lumps. They advocate for integrating surgical options, traditionally reserved for severe cases, with medication and lifestyle adjustments to manage these flares effectively. This approach aims to provide quicker relief and potentially reduce disease progression and recurrence.

Understanding Surgery for Hidradenitis Suppurativa Flares in Different Seasons

Hidradenitis suppurativa (HS) is a long-term skin condition that causes painful lumps, abscesses (pockets of pus), and tunnels under the skin, usually in areas where skin rubs together, like the armpits and groin. People with HS may have "flares", which means their symptoms suddenly get worse. Dr. Tripathi and Dr. Ezaldein looked at when these flares happen and how surgery could help patients feel better, especially during certain times of the year.

Seasonal Flares and Emergency Room Visits

The researchers found that more people with HS visit the emergency room in the summer and fewer go in the winter. Heat and sweat might make the skin condition flare up. Some groups of people, like those who don’t have easy access to dermatologists (skin doctors), are more likely to end up in the emergency room instead of getting regular check-ups.

How Surgery Can Help

Right now, the usual advice is to try medicines first and save surgery for last. But Tripathi and Ezaldein suggest that surgery can sometimes be helpful sooner, even for people whose HS isn’t very severe yet. Surgery can include cutting open and cleaning out the lumps (called incision and drainage), or removing the tunnels under the skin (deroofing or wide excision). These procedures can give fast relief and help prevent worse flares later.

Other quick fixes, like intralesional steroids (medicine injected right into the lumps), can help with pain and swelling, but they don’t give long-lasting results. Surgery to remove the diseased skin usually keeps the problem from coming back for longer. For example, after wide excision, only about 13% of people have the problem return, while it comes back more often after smaller surgeries.

Combining Treatments for Better Results

The experimenters also wrote about using biologics (special medicines that change how the immune system works) together with surgery. One example is adalimumab, which is safe to keep using before and after surgery. However, there isn’t enough information yet about how other biologics, like infliximab or etanercept, work with surgery in HS patients.

Limitations and Future Research

There are some limitations to the study. Most of the information comes from looking back at patient records, not from a controlled experiment. Also, doctors still don’t know which patients will get the most benefit from surgery right away, or how best to combine surgery and medicine. More research with carefully planned studies is needed to learn how surgery affects flares, emergency room visits, and hospital stays.

In the end, Tripathi and Ezaldein believe that combining surgery and medicine early on could help people with HS have fewer and less severe flares, especially during the summer. They hope future studies will look at different ways to treat HS so patients can avoid pain and emergency room visits.

Author(s)

Raghav Tripathi, Harib H Ezaldein

Read Original Paper

https://www.jaad.org/article/S0190-9622(23)00348-1/fulltext