title: Management of severe anogenital acne inversa (hidradenitis suppurativa).
abstract: BACKGROUND
  Severe anogenital acne inversa (AI) is a debilitating chronic inflammatory disease with a major negative effect on quality of life.
  
  
  OBJECTIVE
  To evaluate the role of surgery in the treatment of severe anogenital AI.
  
  
  METHODS
  We analyzed the records of patients with anogenital AI from 2000 to 2010. Assessment was done using the Hidradenitis Suppurativa Lesion, Area, and Severity Index (HS-LASI), pain visual analogue scale, physician global assessment (PhGA), and patient global assessment (PaGA). Comorbidities and adverse events were analyzed.
  
  
  RESULTS
  Sixty-seven patients with a Hurley score of 3 were identified. Mean follow-up was 56.9 ± 41.3 months. A number of comorbidities were observed. After surgery, mean pain scores decreased from 6.3 ± 1.5 to 0.8 ± 0.7, PhGA improved from 6.8 ± 1.2 to 0.9 ± 0.6, PaGA improved from 7.3 ± 1.2 to 1.1 ± 0.5, and HS-LASI decreased from 41.8 ± 21.3 to 2.4 ± 2.8. Adverse reactions were seen in 10.4%. The total relapse rate was 6% (5 patients) with only one case with healing by secondary intention (2% of 49 patients).
  
  
  CONCLUSIONS
  Surgery is the cornerstone of treatment for advanced AI. Healing by secondary intention results in significant reduction of complaints and achieves satisfying body contouring.
authors.affiliation: Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany. wollina-uw@khdf.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Wollina
authors.forename: Michaela
authors.initials: M
authors.lastname: Tilp
authors.forename: Antje
authors.initials: A
authors.lastname: Meseg
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Schönlebe
authors.forename: Birgit
authors.initials: B
authors.lastname: Heinig
authors.forename: Andreas
authors.initials: A
authors.lastname: Nowak
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D005260:Female; D005835:Genitalia; D017497:Hidradenitis Suppurativa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies