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Therapeutic Approach

Hidradenitis suppurativa (HS) is a progressive and debilitating inflammatory skin disease that affects intertriginous regions. Disease severity can be classified using the Hurley staging system. Stage I is characterized by recurrent nodules and abscesses without tunnels or scar. Stage II is characterized by recurrent abscesses with tunnels and scar. Stage III is characterized by broad skin involvement with interconnected tunnels, abscesses, and scar. A combination of medical and surgical approaches is often required for optimal treatment outcomes. In the authors’ experience, stage I HS is typically treated with topical or oral antibiotics. Stage II-III disease requires biologic agents with or without broad-spectrum systemic antibiotics. Nonbiologic systemic agents may be used as adjunctive therapy for medical disease management. Permanently damaged or disfigured tissue (tunnels and scarring) requires surgical removal. Tunnels observed in stage II disease can often be managed with deroofing procedures, whereas surgical excisions are typically required for stage III disease. See Table 76-1.

Table 76-1Hidradenitis Suppurativa Treatment Table

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