Surgical treatments of hidradenitis suppurativa

The treatment of hidradenitis suppurativa (Verneuil's disease) is considered to be both medical and surgical. While this recognises the importance of surgery, the place of surgery among the other treatments (antibiotics and biologics) remains difficult to define: for dermatologists (whose aim is to avoid surgery, sometimes excessively so) and for surgeons (who have a poor understanding of the disease). Emergency surgery is a different matter. Its goal is to incise a collected, highly painful lesion, and serves only a palliative purpose (pain relief); it does not aim to provide definitive treatment of the lesion. Apart from emergencies, the choice between surgery and other treatments is based on an evaluation of the advantages and disadvantages of each modality, and therefore their complementarity: the physical invasiveness, complexity and focal nature of surgery versus the relative simplicity and systemic action of antibiotic/biological therapy. The definitive cure of excisional surgery versus temporary control and dependence on treatment with antibiotic/biological therapy. The intersection between surgery and other treatments must therefore be the considered outcome of a dialogue between the dermatologist and the surgeon.