Perianal hidradenitis suppurativa.

The management of hidradenitis suppurativa is individualized according to the site and extent of the disease. Initially, short-term antibiotics, local care, and incision and drainage are helpful. Unroofing of sinus tracks, total disease excision, and vigorous physical therapy are more beneficial. Primary or secondary closure or closure by an advancement flap or selective split-thickness skin grafting should be considered in some refractory cases. In most areas, recurrence rates are high unless wide excisions are performed, but perianal hidradenitis can usually be managed more conservatively. Patients with intra-anal disease are better allowed to heal secondarily than by grafting. Split-thickness grafts may contract and lead to anal stenosis, and grafts that are rejected may lead to deep scarring and anal dysfunction. The perianal region is best treated by local excision with secondary closure or by unroofing and curettage when the perianal region is more extensively involved.