Effectiveness of wide local excision and secondary intention healing in hidradenitis suppurativa: a single-centre study on quality of life and mental health outcomes.
Alessandra Michelucci, Flavia Manzo Margiotta, Giorgia Salvia, Antonella Vietina, Agata Janowska, Riccardo Morganti, Marco Romanelli, Valentina Dini
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Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life and mental health. Effective management often involves both medical and surgical interventions.
Objectives: To assess the effectiveness of wide local excision and secondary intention healing in improving quality of life and mental health in patients with moderate-to-severe HS.
Methods: A single-centre prospective study was conducted with 40 patients with moderate-to-severe HS that had been refractory to previous treatment. Presurgical mapping of lesions was performed using ultra-high-frequency ultrasound. Patients underwent wide surgical excision followed by secondary intention healing based on HS-TIME (tissue, infection/inflammation, moisture, edges) principles. Quality of life was measured using Skindex-16, and mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with subscales for anxiety (HADS-A) and depression (HADS-D). Assessments were conducted at baseline, 4 weeks after surgery and after complete wound healing. Statistical analyses included paired t-tests and multiple linear regression to determine factors influencing outcomes.
Results: Fourteen men and 26 women with a mean (SD) age of 39 (15) years participated in the study. Significant improvements were observed in Skindex-16 scores (presurgery 57.92, postsurgery 16.03) and HADS scores (HADS-A presurgery 6.13, postsurgery 2.63; HADS-D presurgery 5.50, postsurgery 3.21), indicating reduced pain, discomfort and psychological distress. Multivariate analysis revealed that improvements were associated with male sex, HS stage II disease, longer disease duration and lower body mass index.
Conclusions: Wide local excision combined with secondary intention healing significantly improves quality of life and mental health in patients with HS. The findings suggest that a comprehensive approach addressing both surgical and psychological aspects can enhance patient outcomes. Future research should focus on long-term benefits and the development of standardized postoperative care protocols.
期刊介绍：
Clinical and Experimental Dermatology (CED) is a unique provider of relevant and educational material for practising clinicians and dermatological researchers. We support continuing professional development (CPD) of dermatology specialists to advance the understanding, management and treatment of skin disease in order to improve patient outcomes.
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