What should a surgeon know about hidradenitis suppurativa? - 17/09/23

Doi : 10.1016/j.jviscsurg.2023.07.008

Anne Cecile Ezanno ^a,⁎ , Philippe Guillem ^b, Cécile Gorin ^c, Germaine Gabison ^d, Brice Malgras ^a,^e, Anne-Claire Fougerousse ^f
^a Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
^b Val d’Ouest Clinic, 39, chemin de la Vernique, 69130 Écully, France
^c Psychiatry Department, HIA Sainte-Anne, 2, boulevard Sainte-Anne BP600, 83000 Toulon, France
^d Dermatology, 32, avenue du Maréchal-de-Lattre-de-Tassigny, 94410 Saint-Maurice, France
^e Val de Grâce School, Army Health Service, 75005 Paris, France
^f Dermatology Department, 69, avenue de Paris, 94160 Saint-Mandé, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 17 September 2023
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Highlights

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Hidradenitis suppurativa affects 1% of the population, particularly women (3:1 ratio).

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Its pathophysiology has been imperfectly elucidated; it may be associated with chronic inflammatory bowel disease, spondyloarthropathy, and trisomy 21.

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The diagnosis is based on the association of three clinical characteristics:.

∘	characteristic lesion with nodule, abscess and/or draining fistula;
∘	typical localization (cutaneous folds);
∘	chronic and/or recurrent nature.

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Its evolutivity is appraised by several scores including the Hurley severity score for routine clinical practice, and the Hidradenitis Suppurativa Clinical Response (HiSCR) score regarding disease evolution and clinical research.

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Exacerbated by obesity and smoking, this progressive disease has a major impact on quality of life and entails a risk of suicide.

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According to stage, medical treatment includes antibiotic therapy (in case of flare-up), long-course antibiotic therapy or biologics, but surgery remains the one and only curative option.

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Summary

Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.

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Keywords : Verneuil's disease, Hidradenitis suppurativa, Antibiotherapy, Biotherapy, Surgery