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BACKGROUND:
Hidradenitis suppurativa (HS) is a debilitating disease that causes deep dermal nodules and abscesses to form. Numerous modalities have been utilized for the treatment of HS with varying effectiveness and associated morbidity. For patients with extensive disease, wide surgical excision can dramatically improve the patient's condition. No study to date has evaluated the effect of surgical excision on quality of life in patients with HS.
METHODS:
This study involved retrospective chart review and patient surveying of all patients over the age of 18 that underwent surgical excision of HS at a large, academic medical center between January 1, 2010 and January 1, 2015. Survey content included the Dermatology Life Quality Index (DLQI), a validated quality of life instrument with questions concerning symptoms and feelings, daily activities, leisure, work, and school, personal relationships and treatment. Additional questions specific to HS and to the surgical excision procedure were also included. Retrospective chart review was also utilized to collect patient demographics and surgical details and complications.
RESULTS:
Of the 64 patients that underwent surgical excision for HS during the study period, 26 patients (40.6%; 24 women and 2 men) consented for participation in the study. Eleven patients required more than one surgical excision procedure, with a mean total number of surgical excisions being 1.81±1.41. Mean age at the time of diagnosis was 26.2±13.6 (range=12-68), mean age at the time of first surgical excision was 30.8±12.4 (range=16.4-68.3), and mean time between diagnosis and first surgical intervention was 4.6±5.4 years (range=0.2-19.5 years). Mean BMI at the time of first surgical excision was 37.26±8.36. All patients had tried alternative conservative treatment modalities prior to surgery, with systemic antibiotics (77.0%) being the most common, followed by topical antibiotics (50%), and warm compresses (38.5%). Axilla was the most common location affected by HS (n=22, 84.6%) and the most common area undergoing surgical excision (n=19, 73.1%). Complications included infection (7.7%), patient-reported sensory changes to the upper limb (7.7%), and hematoma (3.8%). The mean difference in DLQI score before HS excision surgery and after excision surgery was statistically significant (p<0.05) by paired t-test for nearly all DLQI questions. When comparing inability to work or study because of HS prior to and after HS excision surgery, a significant reduction in the number of unemployed or unable to study patients was observed (p=0.04). HS did not persist in anatomic areas surgically excised for 73.1% of patients. Overall, 92.3% of patients would choose to have excision surgery again, and 69.2% of patients wish that they had had surgery sooner.
CONCLUSIONS:
Patients with HS report improvements in quality of life after surgical excision and many report that they wish they had surgery closer to the time of diagnosis. Providers should be aware of this surgical option for patients refractory to standard, conservative treatments. Significant improvements to quality of life are observed with this treatment modality.