Deroofing: A tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions

• Published in: Journal of the American Academy of Dermatology Vol. 63; no. 3; pp. 475 - 480
• Main Authors: van der Zee, Hessel H., MD, Prens, Errol P., MD, PhD, Boer, Jurr, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-09-2010
• Subjects: acne inversa; Adult; Cicatrix - prevention & control; Debridement - methods; Dermatology; Dermatology - methods; exteriorization; Female; Follow-Up Studies; hidradenitis suppurativa; Hidradenitis Suppurativa - diagnosis; Hidradenitis Suppurativa - surgery; Humans; Male; Minimally Invasive Surgical Procedures - methods; Patient Satisfaction - statistics & numerical data; Prospective Studies; Risk Assessment; Secondary Prevention; Severity of Illness Index; surgery; Surgical Procedures, Operative - methods; treatment; Treatment Outcome; Wound Healing - physiology; treatment; hidradenitis suppurativa; acne inversa; exteriorization; surgery
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2009.12.018

Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, often refractory to treatment. Patients with HS and dermatologists are in need of an effective, fast surgical intervention technique. Deroofing is a tissue-saving technique, whereby the “roof” of an abscess, cyst, or sinus tract is electrosurgically removed. The use of a probe is mandatory to explore the full extent of a lesion. Objective We sought to evaluate the efficacy and patient satisfaction of the deroofing technique for recurrent Hurley I (mild) or II (moderate) graded HS lesions at fixed locations. Methods An open study consisted of 88 deroofed lesions in 44 consecutive patients with HS, treated by a single clinician with a follow-up time of up to 5 years. Results Fifteen of 88 (17%) treated lesions showed a recurrence after a median of 4.6 months. In all, 73 treated lesions (83%) did not show a recurrence after a median follow-up of 34 months. The median patient satisfaction with the procedure rated 8 on a scale from 0 to 10. Of the treated patients, 90% would recommend the deroofing technique to other patients with HS. One side effect occurred in the form of postoperative bleeding. Limitations Some patients were lost to follow-up. Conclusions The deroofing technique is an effective, simple, minimally invasive, tissue-saving surgical intervention for the treatment of mild to moderate HS lesions at fixed locations and it is suitable as an office procedure.