Surgical Treatment versus Medical Treatment in Hidradenitis Suppurativa: an integrative review and comparative analysis of clinical outcomes and quality of life

Abstract

Hidradenitis Suppurativa (HS) is a chronic, recurrent, and painful inflammatory disease of the hair follicles, whose medical and surgical management still represents a significant therapeutic challenge for modern dermatology. Characterized by deep nodules, abscesses, fistulas, and hypertrophic scars, HS affects areas of skin friction and exerts a devastating impact on quality of life, with major physical, psychological, and social repercussions. In recent decades, advances in the understanding of the immunoinflammatory pathophysiology of the disease have driven the development of targeted therapies, such as biologic agents, while more precise and conservative surgical techniques have been refined to reduce recurrence rates and promote functional rehabilitation. This study aims to conduct an integrative and comparative literature review of the clinical outcomes and quality of life of patients undergoing surgical versus medical treatment for Hidradenitis Suppurativa, analyzing evidence published between 2015 and 2025. Randomized trials, systematic reviews, and meta-analyses indexed in PubMed, Scielo, Embase, and ScienceDirect were included, addressing therapeutic efficacy, remission time, recurrence rates, complications, and psychosocial impact. The literature findings indicate that medical treatment—particularly the combined use of antibiotics and biologic agents such as adalimumab—provides significant inflammatory control and symptomatic improvement in mild to moderate stages, but with a high recurrence rate after discontinuation. In contrast, surgical treatment, including techniques such as deroofing and wide excision, shows better long-term remission rates and significant reductions in recurrence, although it involves longer recovery times and a higher risk of local complications. It is concluded that the ideal approach should be individualized and multimodal, integrating medical and surgical strategies combined with the management of metabolic comorbidities, smoking cessation, and psychological support. A deeper understanding of the interaction between chronic inflammation, skin microbiota, and psychosocial factors may, in the future, redefine therapeutic paradigms, enabling more personalized and effective treatments.