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August 19, 2020

Multidisciplinary Update on Genital Hidradenitis Suppurativa: A Review

Author Affiliations
  • 1University of North Carolina at Chapel Hill School of Medicine
  • 2Department of Urology, University of North Carolina at Chapel Hill
  • 3Department of Dermatology, University of North Carolina at Chapel Hill
JAMA Surg. 2020;155(10):970-977. doi:10.1001/jamasurg.2020.2611
Abstract

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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