A Multidisciplinary Model to Managing Patients with Hidradenitis Suppurativa at a Single-center Wound-care Clinic

PURPOSE: A multitude of treatment options exist for hidradenitis suppurativa (HS), however, no single effective therapy has been proven to be most successful in symptom control and wound healing. Single-approach treatments are often inadequate and lead to long-standing disease and recurrence. The purpose of this report is to present the effectiveness of a multidisciplinary care team approach in the treatment of HS at a single-center, comprehensive, wound care center. METHOD: We describe our treatment approach and outcomes of patients with HS seen at our tertiary wound care center. Retrospectively identified the patients at our wound care clinic who had HS managed with a multidisciplinary care team approach. Patient demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the number of procedural interventions, emergency department (ED) visits, and length of treatment. RESULTS: Medical optimization is of the utmost priority; diabetic control and smoking cessation are required before surgery. Patients who are sicker, non-compliant, or do not achieve medical optimization (e.g. continued tobacco use) are managed with a three-month antibiotic course, dressing changes, and expectant management. Surgical decision-making is dependent on a multitude of additional factors, primarily including location of disease and stage. Surgery performed on axillary lesions are often performed first, as lesions in this area are more amenable to surgical closure and have better operative outcomes. Patients with perianal or groin disease are less amenable to surgical wound closure due to the paucity of local tissue and anatomic proximity, and often require more specialized care. Those with perianal disease receive a diverting colostomy. Those with Hurley stage III receive Humira prior to surgery to decrease the size of the operated lesion. Recurrence rates are high, especially among those non-compliant with treatment. From 2010 to 2021, 196 patients with HS were managed under the care of plastic and reconstructive surgery, general surgery, rheumatology, urology, gynecology, and/or dermatology. There were 140 females (71.4%) and 56 males (28.6%). The mean age at time of initial visit was 38.7 ± 14.7 years and mean BMI was 32.7 kg/m2. 87 patients had a history of smoking (44.4%), and 39 patients had diabetes (19.9%). 60 patients (30.1%) had a history of ED admission for HS-related complications, with a median of two inpatient admissions per patient (IQR=1,6.5, range 1-16). After initial consultation, 133 (67.9%) patients received procedural interventions, with an average number of procedures of 4.18 + 4.92. The remaining patients either did not require surgery for their lesions or were determined poor candidates for surgery. Mean follow-up time was 3.52 ± 2.85 years. CONCLUSION: We present the results of using a multidisciplinary team approach to the management of HS. Our results indicated Hurley staging, location of HS lesions, and medical optimization can indicate whether a patient should expect to undergo at least one or more procedures for their HS. We present evidence of a high disease burden and use of emergency services among this population, indicating the necessity for a more methodical approach utilizing multidisciplinary care for appropriate disease management.