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Purpose of Review <p>Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by painful nodules, abscesses, tunnels, and scarring. While medical therapy is often the first-line approach, procedural interventions are essential for managing recurrent or persistent sites of disease activity. This narrative review summarizes surgical nomenclature and current evidence on four major surgical interventions—unroofings (or deroofings), excisions, CO₂ laser-based excision, and skin-tissue-sparing excision with electrosurgical peeling (STEEP)—including their indications, efficacy, risks, and perioperative considerations.</p> Recent Findings <p>Unroofings are a minimally invasive, tissue-sparing procedure effective across all Hurley stages with high patient satisfaction. Excision removes affected tissue in a deeper plane than unroofing, which allows for reconstruction when desired, though it may result in higher morbidity and prolonged wound care post-operatively. CO₂ laser-based excision provides an alternative approach with low recurrence risk, though healing may take longer compared with deroofing. The STEEP procedure offers a hybrid approach similar to unroofing with electrosurgical removal of tissue overlying tunnels.</p> Summary <p>Across all procedures, perioperative continuation of medical management, including immunomodulators, is generally considered safe and helpful for continued disease control. Imaging modalities (e.g., ultrasound, thermography) may play a role in surgical planning in some instances as well. Wound healing by secondary intention is common, with post-operative care protocols tailored to the procedure type and the anatomical site. Optimizing perioperative management and access to surgical expertise are crucial for improving outcomes in this challenging patient population.</p>

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Procedural Interventions for Hidradenitis Suppurativa: A Narrative Review

  • 期刊论文

  • 发表日期：

    2025年9月26日

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  • Teja Mallela,
  • Charles Teames,
  • Javairia Haq,
  • Luke Passannante,
  • Leslie Onyeji,
  • Christopher Sayed

摘要

Purpose of Review

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by painful nodules, abscesses, tunnels, and scarring. While medical therapy is often the first-line approach, procedural interventions are essential for managing recurrent or persistent sites of disease activity. This narrative review summarizes surgical nomenclature and current evidence on four major surgical interventions—unroofings (or deroofings), excisions, CO₂ laser-based excision, and skin-tissue-sparing excision with electrosurgical peeling (STEEP)—including their indications, efficacy, risks, and perioperative considerations.

Recent Findings

Unroofings are a minimally invasive, tissue-sparing procedure effective across all Hurley stages with high patient satisfaction. Excision removes affected tissue in a deeper plane than unroofing, which allows for reconstruction when desired, though it may result in higher morbidity and prolonged wound care post-operatively. CO₂ laser-based excision provides an alternative approach with low recurrence risk, though healing may take longer compared with deroofing. The STEEP procedure offers a hybrid approach similar to unroofing with electrosurgical removal of tissue overlying tunnels.

Summary

Across all procedures, perioperative continuation of medical management, including immunomodulators, is generally considered safe and helpful for continued disease control. Imaging modalities (e.g., ultrasound, thermography) may play a role in surgical planning in some instances as well. Wound healing by secondary intention is common, with post-operative care protocols tailored to the procedure type and the anatomical site. Optimizing perioperative management and access to surgical expertise are crucial for improving outcomes in this challenging patient population.