Dermatologist Magnoni: "Surgery and biological drugs in hidradenitis suppurativa"

"Medical therapy and surgical therapy are allies in an integrated management of hidradenitis suppurativa (HS), which requires a very high level of personalized care". In fact, "we can successfully address this disease thanks to medical therapies, biological drugs and surgical therapies, which can be administered individually or in combination". This is how Cristina Magnoni, professor of Dermatology at the University of Modena and Reggio Emilia and head of the Departmental Unit of Dermatological Surgery, comments on the reimbursement, by the National Health Service, of secukinumab, a recombinant fully human monoclonal antibody selective for interleukin-17A, in the treatment of moderate to severe active hidradenitis suppurativa (acne inversa) in adults with an inadequate response to conventional systemic therapy for HS, a complex disease with a strong psychological impact.

"We should no longer think that pharmacological therapy and surgical therapy are in opposition - clarifies Magnoni - on the contrary, we are increasingly talking about a strategic integration between biological drugs and surgery, an aspect also underlined in our new Guidelines that suggest not interrupting biological drugs in anticipation of surgery, because therapy with biological drugs can contain inflammation, avoid flare-ups before surgery and can prevent recurrences of lesions, which can remain after surgery".

Hidradenitis suppurativa is in fact "a chronic inflammatory dermatological disease - explains the expert - that affects the apocrine glands and therefore all the body regions where they are present: axillary, inguinal, perineal, mammary and gluteal. There are various degrees of severity of the disease, which manifests itself with inflammatory lesions, abscesses, draining fistulas and disabling scars. In the mild forms - she specifies - the lesions are few, in the medium severity forms the inflammatory lesions, such as fistulas and scars, are greater, but they affect separate areas of the skin and, then, in the more serious forms, these lesions tend to merge into large inflammatory areas that are very debilitating for the patient's life".

"The new European guidelines - continues Magnoni - indicate that surgery plays a very important role in the available therapies for hidradenitis suppurativa, an aspect that distinguishes it from other chronic inflammatory skin diseases, such as psoriasis or atopic dermatitis. In this disease, the dermatological surgeon is fundamental, especially in advanced cases, when we need to widen the surgical sections to remove diseased tissue and in the subsequent tissue reconstruction, which restores function and a good quality of life to the patient".

There are various types of interventions "that can be performed for this disease: from minimally invasive procedures - explains the specialist - such as incision, drainage of an abscess or deroofing, to major surgical procedures such as wide local excision, which involves the wide resection of the areas affected by the disease, which then requires reconstruction with autologous skin grafts or bioengineered skin or flaps". It is "a gradual approach", like the pharmacological one, which "intensifies with the increase in severity of the disease and, obviously, the presence of irreversible damage such as draining and multiple fistulas or scars".

Hidradenitis suppurativa "is a chronic disease with a significant inflammatory basis and therefore requires an integrated approach - Magnoni points out - The dermatological surgeon must work in a multidisciplinary team with an internist, infectious disease specialist, proctologist surgeon, gynecologist, urologist and psychologist to build a personalized path for the patient. This path, in fact, includes the administration of biological target therapies, surgical therapies, but also nutritional support and, when necessary, support to stop smoking. Only in this way - he concludes - can we offer effective care to our patient".