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Successful Management of Refractory Scalp Hidradenitis Suppurativa
Ryan Enslow BS, Kerry-Ann Mitchell MD-PhD
The Ohio State University College of Medicine
2025-01-10
Presenter: Ryan Enslow
Affidavit:
We certify that the work submitted is original and wholly conducted by the authors listed in the submission.
Director Name: Kerry-Ann Mitchell
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND - Hidradenitis suppurativa (HS) is a chronic skin condition affecting 1-4% of people, disproportionately impacting African Americans, who are nearly three times more likely to develop it. The condition causes painful lumps, abscesses, and scarring, taking a toll on physical and mental well-being. Managing HS is costly, with the U.S. spending over $2 billion a year on medical visits, and treatments. Patients with HS report some of the lowest quality-of-life scores among skin conditions. These struggles highlight the need for better treatment options and support for those living with this challenging condition.
METHODS - Here we present a case of a 41-year-old male with extensive Hurley stage III hidradenitis suppurativa (HS) of the scalp refractory to medical therapy and impacting his daily life, who underwent successful surgical management.
RESULTS - The patient underwent staged surgical reconstruction. The first stage involved wide local excision of diseased scalp skin, Integra placement, and wound VAC application. The second stage included sharp debridement, advancement of a posterior scalp flap, and split-thickness skin grafting. The patient tolerated both surgeries well with no complications. At six-week follow-up, the skin graft remained viable, and the patient reported improved quality of life.
CONCLUSION - This case demonstrates the successful management of severe scalp HS using a staged surgical approach. This approach can be considered in patients with refractory disease to improve quality of life and address the significant functional and psychological impact of scalp HS.
