Hidradenitis Suppurativa: Perspectives of a Surgeon and a Dermatologist (Clinical Case Report)

Background . Hidradenitis suppurativa, also known as acne inversa, is a chronic, recurrent inflammatory skin disease of follicular origin that affects the apocrine gland-bearing regions. The terminological duality of the disease and the polymorphism of its clinical presentation, encountered by both surgeons and dermatologists, frequently contribute to a substantial diagnostic delay and to the absence of a unified patient care pathway. Case presentation . We report the case of a female patient whose disease began at the age of 28 and in whom the correct diagnosis was established only 13 years later, after she had passed through surgical, gynaecological and immunological care. By the time hidradenitis suppurativa of Hurley stage III was diagnosed, the process was disseminated and accompanied by metabolic comorbidities. Management was provided by a multidisciplinary team and combined staged surgical treatment with sequential systemic therapy: first isotretinoin and subsequently biologic agents, initially adalimumab and then secukinumab. Systemic anti-inflammatory therapy helped to reduce disease activity and to localise the process, allowing surgery to be performed less extensively and with less morbidity; however, by the time pathogenetically targeted therapy was initiated, the patient had already developed irreversible scarring and permanent disability. Conclusion . The case demonstrates that in hidradenitis suppurativa medical and surgical treatment are not alternative but complementary, sequentially applied modalities, and that early recognition of the disease and continuity of care between specialists are of key importance. The management of the patient was further complicated by the fact that national clinical guidelines for the disease were not approved in Russia until 2025. The management strategy, built on an understanding of the pathogenesis, the available drugs and the individual characteristics of the patient, subsequently proved consistent with these guidelines.