Predictors for Remission Versus Refractory Disease Following Wide Local Excision Surgery for Hidradenitis Suppurativa: A Single-Center Case–Control Analysis

Hidradenitis suppurativa (HS) is a chronic skin disease with a significant psychosocial burden. Skin of color (SOC) populations remain underrepresented in HS literature. Surgical excision is often pursued after failed medical management, but predictors of post-surgical disease recurrence are not well characterized. This study aimed to identify non-surgical risk factors associated with persistent, refractory HS despite medical and surgical intervention in a predominantly SOC patient population. A retrospective chart review was conducted on 31 adult HS patients with prior excision surgery. Patients were categorized into remission (n=15) or refractory (n=16) cohorts. Demographic, clinical, and surgical data were extracted from the electronic medical record. There was no association between surgical closure technique and refractory disease (p=0.5936). Patients with refractory disease were more likely to be active smokers at the time of surgery (68.8% vs. 33.3%, p=0.0486), have groin or perineal involvement (p=0.0059; p=0.0185), and have psychiatric comorbidities (75% vs. 33.3%, p=0.0198). Female patients with gynecological comorbidities or evidence of female hormone dysregulation were significantly more likely to achieve remission after excision surgery (p=0.0024). Active cigarette smoking and groin/perineal involvement are significant predictors of refractory disease despite surgical intervention. While all HS patients should be screened for psychosocial burden of disease, patients with refractory disease may be at higher risk of comorbid psychiatric illness. Further research is needed to illicit the role of female hormone level dysregulation in HS pathophysiology and post-operative outcomes. Limitations include a small sample size and single-institution, retrospective nature of the study.