The role of surgery in hidradenitis suppurativa: expert-based holistic approaches

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by painful nodules and tunnels, which are predominantly found in intertriginous skin areas such as the axillary, inguinal and anogenital regions. The condition significantly impacts patients' quality of life owing to its chronicity and debilitating nature. While a combined medical and surgical approach is recommended for severe cases, misconceptions exist regarding the role and timing of surgery for HS, often influenced by patient fear and hesitation. A comprehensive, multidisciplinary approach involving a multimodal therapeutic strategy is essential for successful HS outcomes. The decision to opt for surgery depends on various factors such as disease severity, lesion characteristics, anatomical location and patient preferences. Although surgery remains a cornerstone in managing recurrent and severe cases of HS, surgical interventions, when combined with targeted medical therapies, can lead to favourable outcomes and improved disease control. This review aims to guide clinicians in decision making around the suitability of surgery by providing a framework for surgery in HS in the context of various clinical scenarios.