Hidradenitis Suppurativa (Hurley I/II): Serial Excisions with Primary Wound Closure Under Local Anesthesia As Most Adequate Treatment Approach

BACKGROUND: Acne inversa as a chronic inflammatory disorder can be divided into three stages according to Hurley’s classification. It affects the axillary and anogenital region predominantly, and its chronic course of development is associated with a major negative impact on quality of life, especially in young patients. We discuss the different types of treatment in patients with acne inversa and the benefits of two-stage surgical treatment by serial excisions with primary wound closure under local anaesthesia. CASE REPORT: We present a 28-year-old man with hidradenitis suppurativa stage I in the right axillary region and also in the pubic area. The patient is an active smoker. The patient was treated with Rifampicin 2x 300mg / day without any particular effect and preoperatively, systemic therapy with Clindamycin 4x 600mg / day was performed, combined with daily dressings with jodasept ointment for 7 days. The patient was treated through two surgical sessions under local anaesthesia with elliptical excision of the lesions located in the right axillary and the pubic area. Both of the two surgical defects were initially closed with single interrupted sutures. Histological examination of both lesions revealed the presence of suppurative folliculitis. CONCLUSION: The literature describes various methods for treating acne inversa which include both systemic and local approaches. However, it is considered that drug therapy achieves only a temporary improvement in patients with hidradenitis suppurativa. For this reason, the surgical treatment of acne inversa is indicated as the only curative treatment, especially for recurrent lesions and serial excisions under local anaesthesia, followed by primary wound closure is a valuable treatment for patients with mild to moderate HS (Hurly stage I & II).