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Multidisciplinary Update on Genital Hidradenitis SuppurativaA Review

Educational Objective
To review the management of genital hidradenitis suppurativa for prevention, treatment, and reconstruction of genital defects.
1 Credit CME

Importance  Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a predilection for the genital region. Genital HS requires medical and surgical management as well as close collaboration among a multidisciplinary team.

Observations  Hidradenitis suppurativa is a disease of the hair follicles that results in recurrent nodules, abscesses, and tunneling sinus tracts. Medical treatment mainstays include antibiotics and retinoids, but the evolving class of biologic medications has gained traction in the treatment of moderate and severe disease. Many of the medical therapies come with adverse effects requiring clinical and laboratory monitoring over the course of treatment. When lesions are refractory to therapy or are too large for medical therapy alone, surgical intervention is required. Surgical procedures can include treatment of affected areas with deroofing or excision of affected skin. When large portions of genital skin are removed, reconstruction is necessary to restore function and aesthetics of the genitals. We describe a variety of reconstructive techniques based on the size and location of the skin deficiency.

Conclusions and Relevance  Effective management of genital hidradenitis suppurativa requires a thorough understanding of medical and surgical techniques for prevention, treatment, and reconstruction of genital defects.

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Article Information

Corresponding Author: Bradley D. Figler, MD, Department of Urology, University of North Carolina at Chapel Hill, 170 Manning Dr, 2113 Physicians Office Bldg, Chapel Hill, NC 27599 (figler@unc.edu).

Published Online: August 19, 2020. doi:10.1001/jamasurg.2020.2611

Accepted for Publication: March 21, 2020.

Conflict of Interest Disclosures: Dr Sayed reports the following disclosures: AbbVie (speaker, investigator, and consulting), Novartis (speaker and investigator), InflaRx (investigator), and UCB (investigator and advisory board). No other disclosures were reported.

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