Surgical excision best tx for hidradenitis suppurativa, expert says. (Anogenital Disease).

HOUSTON -- Surgery remains the treatment of choice for patients plagued by anogenital hidradenitis suppurativa, Dr. Peter J. Lynch said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

Surgical excision is the only approach that truly eliminates the disorder's painful, inflamed, disfiguring nodules characteristic of this disorder, he said.

Antibiotics are of limited efficacy. Corticosteroids administered systemically for 5-7 days relieve inflammation only temporarily Dermatologists rarely perform this type of surgery, so often the task falls to the gynecologist or gynecologic surgeon.

"It's better to do a narrow excision and leave active disease on the margins than a more extensive procedure because the disease will recur at the surgical site anyway," Dr. Lynch said.

It's important to warn patients that the condition usually recurs, so they'll probably need surgery more than once. The nodules have a significant impact on quality of life because they hurt, rupture, leave scars, rub against clothing, and interfere with sexual intercourse. Most patients are "deliriously happy" to have them removed with surgery and generally are willing to undergo surgery again later if needed, said Dr. Lynch, professor emeritus of dermatology at the University of California, Davis.

Hidradenitis suppurativa occurs in hair follicles above apocrine ducts in the "milk line"--the axillas, breasts, central abdomen, and anogenital area--that become blocked and cannot ...