title: What Heals Hidradenitis Suppurativa: Surgery, Immunosuppression, or Both?
abstract: BACKGROUND
  Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin that is a significant source of impaired quality-of-life for affected individuals. For patients with refractory disease, radical resection of all involved tissue may offer the only potential option for a cure. However, high rates of recurrence after wide local excision have led investigators to seek alternative therapeutic combinations. We present our experience and a literature review.
  
  
  METHODS
  A comprehensive literature review (1982-2016) was performed on PubMed and Ovid MEDLINE, using key words relevant to HS.
  
  
  RESULTS
  A total of 1842 publications were identified, and 15 publications were included in this review on: surgical intervention (n = 10), biologic therapy (n = 4), and joint surgical and biologic treatment (n = 1) of HS. The treatment type, level of evidence, and key findings are assessed and discussed.
  
  
  CONCLUSIONS
  Recent trials demonstrating the safety and efficacy of biologic therapy alone in patients with moderate-to-severe HS have spurred questions regarding the potential utility of these agents as adjuncts to more traditional surgical interventions. The results of the literature search advocate a role for radical resection and biologic therapy in the setting of moderate-to-severe disease. Preliminary results from limited case series suggest a potential role for combined management in the setting of advanced, recalcitrant disease.
authors.affiliation: Washington, D.C.|From the Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital.
authors.forename: Reuben A
authors.initials: RA
authors.lastname: Falola
authors.affiliation: Washington, D.C.|From the Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital.
authors.forename: Michael V
authors.initials: MV
authors.lastname: DeFazio
authors.affiliation: Washington, D.C.|From the Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital.
authors.forename: Ersilia L
authors.initials: EL
authors.lastname: Anghel
authors.affiliation: Washington, D.C.|From the Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital.
authors.forename: Carol Deane B
authors.initials: CDB
authors.lastname: Mitnick
authors.affiliation: Washington, D.C.|From the Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
authors.affiliation: Washington, D.C.|From the Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Evans
mesh_terms: D003131:Combined Modality Therapy; D062109:Dermatologic Surgical Procedures; D017497:Hidradenitis Suppurativa / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents