Management of penoscrotal hidradenitis: a narrative review

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful lesions primarily in apocrine gland-bearing regions, with scrotal involvement in 6% of male patients. Despite its notable prevalence, particularly in Western countries, HS remains frequently under-reported, leading to delays in diagnosis and treatment that exacerbate disease prognosis and significantly diminish patients' quality of life. The complex etiology of HS involves a multifactorial pathogenesis including genetic, anatomical, immunological, and environmental factors, which also contribute to mental health challenges in affected individuals. While medical management is essential, surgical intervention is crucial for managing moderate to severe HS, providing symptomatic relief, infection control, and reduced recurrence rates. This narrative review consolidates current understanding of HS, focusing on its epidemiology, pathophysiology, clinical features, and management strategies. It highlights contemporary surgical techniques ranging from tissue-sparing surgery to wide excision of involved tissue, emphasizing the importance of a multidisciplinary approach that incorporates multimodal therapy and newer biological treatments. Additionally, the review discusses options for surgical reconstruction, particularly techniques such as skin grafts and flaps that are best suited for the male genitalia, addressing the unique challenges in this area. Ultimately, this review aims to enhance awareness and foster improved treatment outcomes for those affected by HS.