Management of Severe Anogenital Acne Inversa (Hidradenitis Suppurativa)

BACKGROUND Severe anogenital acne inversa (AI) is a debilitating chronic inflammatory disease with a major negative effect on quality of life. OBJECTIVES To evaluate the role of surgery in the treatment of severe anogenital AI. METHODS We analyzed the records of patients with anogenital AI from 2000 to 2010. Assessment was done using the Hidradenitis Suppurativa Lesion, Area, and Severity Index (HS-LASI), pain visual analogue scale, physician global assessment (PhGA), and patient global assessment (PaGA). Comorbidities and adverse events were analyzed. RESULTS Sixty-seven patients with a Hurley score of 3 were identified. Mean follow-up was 56.9 +/- 41.3 months. A number of comorbidities were observed. After surgery, mean pain scores decreased from 6.3 +/- 1.5 to 0.8 +/- 0.7, PhGA improved from 6.8 +/- 1.2 to 0.9 +/- 0.6, PaGA improved from 7.3 +/- 1.2 to 1.1 +/- 0.5, and HS-LASI decreased from 41.8 +/- 21.3 to 2.4 +/- 2.8. Adverse reactions were seen in 10.4%. The total relapse rate was 6% (5 patients) with only one case with healing by secondary intention (2% of 49 patients). CONCLUSIONS Surgery is the cornerstone of treatment for advanced AI. Healing by secondary intention results in significant reduction of complaints and achieves satisfying body contouring.