If you have HS, you may be offered a procedure for persistent lumps, tunnels or scarring that has not improved enough with medical treatment. You should know that surgery is not automatically needed for everyone with HS.
You and your dermatologist can choose a procedure based on your disease, such as deroofing for a localised tunnel or wider excision for more extensive disease. Surgery can treat established HS in one area, but it does not prevent new lesions elsewhere.
When Is Surgery Considered for Hidradenitis Suppurativa?
You may be considered for HS surgery when you have a specific area that keeps causing problems despite suitable medical treatment. You may have a recurring lump, a draining tunnel or scarring with repeated inflammation.
You and your dermatologist can consider how long the problem has lasted, how often it returns and how much it affects daily life. You should know that widespread HS is not required for surgery to be discussed, because a persistent tunnel or recurring lesion in one area may suit a local procedure.
Why Doesn’t Surgery Automatically Cure HS?
You should know that HS is a chronic inflammatory condition, so surgery can treat established disease in one area without removing your tendency to develop HS elsewhere. You may have successful surgery in one area and later develop lesions somewhere else.
You and your dermatologist can therefore treat surgery as part of a broader HS plan rather than a permanent cure. Your medical treatment may continue alongside surgery to help control inflammation, while the procedure aims to reduce your pain, drainage and recurring disease in the affected area.
UK Guidance Note
British Association of Dermatologists guidance explains that established HS tunnels and scarring may require surgery because these structural changes may not respond adequately to medical treatment alone. Deroofing can be used for selected tunnels, while larger or deeper areas of scarring may require wider excision. Medical treatment may still be needed alongside surgery because HS can remain active in other areas.
Could Deroofing Be an Option for Your HS?
You should know that deroofing is a tissue sparing procedure used for selected HS tunnels or localised chronic disease. Your surgeon removes the skin forming the roof of the tunnel, cleans the area and leaves the wound open to heal naturally over the following weeks.
You and your dermatologist can consider deroofing when a defined, recurring tunnel or lesion affects a limited area. You should know that the procedure is not suitable for every HS pattern, so the surgeon will assess its extent and location first.
Evidence Note
European HS guidance describes deroofing as a tissue sparing procedure that can be particularly useful for selected recurrent tunnels, often under local anaesthetic. The available evidence is mainly based on observational studies rather than large randomised trials, so recurrence estimates vary and should not be treated as a guaranteed outcome for an individual patient.
How Do the Main HS Procedures Differ?
You should know that the procedure you may be offered depends on how much HS tissue is affected. Incision and drainage may relieve an acute abscess but does not treat the underlying HS, while you may be offered deroofing for a localised tunnel or limited excision for a persistent area. More extensive disease may require wide excision, sometimes with a skin graft or flap.
You and your surgeon can choose the approach based on the size, depth and location of your HS. You should also know that larger procedures usually involve bigger wounds and longer recovery, while more extensive surgery may sometimes reduce the chance of disease returning in that treated area.
When Might You Need Local or Limited Excision?
You may be offered local excision when you have a recurring HS nodule, abscess or tunnel confined to a small area. Your surgeon removes the affected tissue, and the wound may be closed or left to heal naturally depending on its size and location.
You should know that local excision does not guarantee that your HS will not return. You and your surgeon can assess how much disease is present so the procedure removes the affected area without unnecessary surgery.
When Might You Need Wide Excision?
You may be offered wide excision when you have extensive or longstanding HS with connected tunnels and significant scarring in one area. Your surgeon removes a larger amount of affected skin and underlying tissue to treat established disease rather than repeatedly treating individual lumps.
You should know that wide excision can leave a larger wound and may require longer healing or reconstruction with a graft or flap. You and your surgeon can decide which approach may be most appropriate based on the size, depth and location of your HS and how much tissue needs to be removed.
How Do HS Procedures Compare?
| Procedure | When it may be considered | Typical wound approach | Important limitation |
| Incision and drainage | Acute painful abscess needing rapid relief | Small opening to release fluid | Often gives temporary relief and does not treat chronic tunnels |
| Deroofing | Selected recurrent or draining tunnels in a localised area | Usually left open to heal naturally | Recurrence can still occur and it is not suitable for every HS pattern |
| Local excision | Persistent disease confined to a relatively small area | May be closed or left to heal depending on the defect | Disease can recur in or around the treated area |
| Wide excision | More extensive tunnels, fibrosis or scarred regional disease | May heal naturally or require graft/flap reconstruction | Larger wounds and longer recovery are usually involved |
When Is Incision and Drainage Used for HS?
You should know that incision and drainage is different from deroofing or excision. If you have a painful, swollen abscess, the surgeon may open it to release trapped fluid and give you short-term relief, but the underlying HS remains and the area may flare again.
You and your dermatologist can consider drainage when short-term relief is needed, while also discussing why the same area keeps recurring. You can then ask whether medical treatment, further assessment or a longer term procedure may be more appropriate.
Research Insight
Studies comparing HS operations report very different recurrence rates because definitions of procedures, wound closure, disease severity and follow-up vary considerably. Some systematic reviews have reported lower recurrence after wider excision than after more limited excision, although the evidence is heterogeneous and wider procedures generally create larger wounds with greater recovery or reconstruction needs. This is why recurrence percentages should guide discussion rather than predict an individual result.
What Can Affect Your Risk of HS Returning After Surgery?
Your chance of recurrence can depend on the location and extent of your HS, the procedure used and how the wound is managed. You should know that ongoing inflammatory activity can also influence what happens after surgery.
You and your surgeon can use these factors to discuss realistic expectations rather than relying on one published percentage. You may find that the most appropriate procedure balances recurrence risk with wound size, healing time and the effect on your daily life.
How Does Your Surgeon Decide Which Procedure You Need?
Your surgeon will look beyond the most obvious lump when deciding which HS procedure may suit you. You can expect the decision to consider disease pattern, previous treatment and how surgery could affect daily life.
- Extent of Your HS: Your surgeon can assess whether you have a single recurring lesion, localised tunnel, connected tunnels or more extensive scarring.
- Location of the Disease: You should know that where your HS occurs can influence which procedure and wound healing approach may be suitable for you.
- History of Recurrence: You may be asked how often your HS becomes inflamed, whether it drains repeatedly and how long the same area has persisted.
- Previous Treatment and Procedures: You and your surgeon can discuss which medical treatments or procedures you have already tried and how well they worked.
- Your Health and Preferences: You can discuss your general health, daily activities and preferences when considering a smaller procedure or a more extensive surgical approach.
There is no single HS procedure that suits everyone, so you and your surgeon can use these factors to narrow the options. Together, you can weigh wound size, recovery and recurrence against practical priorities.
What Should You Discuss Before Surgery?
Before you agree to HS surgery, you should understand what the surgeon plans to remove and how the wound is expected to heal. You can ask whether the procedure will treat a single nodule, a tunnel, connected tunnels or a larger scarred area, and whether closure may involve natural healing, stitches, a graft or a flap.
You and your surgeon should discuss dressings, recovery and when you may return to work, exercise or driving. You should also tell the surgical team about biologic therapy or other medicines, smoking, diabetes or previous wound healing problems because these factors can affect planning and recovery.
Clinical Tip
If your HS changes significantly between appointments, photographs of recurrent swelling or drainage can help your clinical team understand how the area behaves over time. Before surgery, make sure you know whether the goal is temporary symptom relief, treatment of a specific tunnel or removal of a larger area of established tunnelled or scarred tissue.
What Happens During Deroofing?
You may have deroofing under local anaesthetic when your HS is limited to a manageable area. Your surgeon removes the roof of the tunnel and usually leaves the area open to heal naturally from the base upwards. Healing may take several weeks, depending on the size and location of the treated area.
You should know that healing time depends on the size and depth of the wound. You and your surgeon can discuss expected recovery and wound care while recognising that study results cannot predict exactly how the treated area will respond.
What Might Your Recovery Be Like After Excision?
You should know that your recovery after HS surgery depends on how much tissue is removed and how your wound is managed. A smaller excision may need less recovery time, while a wider excision can mean a larger wound and longer healing, sometimes with a graft or flap.
You may have some discomfort, swelling or drainage after surgery and will need to follow the wound care instructions provided. You and your surgeon can discuss expected recovery, while the final scar may continue to change for several months.
When Should You Ask About HS Surgery?
You may want to discuss surgery with your dermatologist if the same HS lesion keeps returning, a tunnel continues to drain or scarring causes ongoing pain. You should know that this does not automatically mean an operation is needed, because the area first needs to be assessed for a suitable procedure.
If repeated drainage has not stopped the same lesion from returning, you can ask whether deroofing or excision may address the underlying problem. You can also bring details of previous treatment and photographs of flares to help the team understand your HS over time.
Myth vs Fact
| Myth | Fact |
| HS surgery permanently cures the condition. | Surgery can remove established tunnels and scarred tissue from a treated area, but HS is a chronic inflammatory condition and new disease can still develop elsewhere or sometimes recur near the operated site. |
| A bigger operation is always better. | The most extensive operation is not automatically the most appropriate. The choice depends on the extent of established tunnels and scarring, the location of disease, expected wound size and the effect of surgery on function and recovery. |
| Incision and drainage treats the underlying HS. | Drainage can relieve an acute painful abscess, but it does not remove chronic tunnels or the underlying tendency to develop HS. Further medical or surgical treatment may still be required. |
| Deroofing and wide excision are essentially the same procedure. | Deroofing is a tissue sparing procedure that removes the roof of selected tunnels, while wide excision removes a larger area of irreversibly affected tissue. |
| Medical treatment is no longer needed once you have surgery. | Surgery and medical treatment often have complementary roles. Medicines can help control inflammation more broadly, while surgery addresses persistent tunnels and scarred tissue. |
| A low recurrence percentage from a study tells you exactly what will happen after your operation. | Recurrence results differ between studies because disease severity, surgical definitions, wound closure and follow-up vary. Your own outcome cannot be predicted from one published percentage. |
Key Takeaways
- HS surgery is most useful for persistent tunnels, recurrent localised disease and irreversible scarring rather than every active flare.
- Deroofing is a tissue sparing option for selected tunnels, while wider excision may be considered when structural disease is more extensive.
- Incision and drainage can relieve an acute abscess but is usually not a definitive treatment for chronic HS.
- Surgery treats the area operated on but does not remove the underlying tendency to develop HS elsewhere.
- Medical treatment and surgery can be used together because they address different parts of the disease.
- Recovery and recurrence vary according to the procedure, disease location, wound management method and individual circumstances.
Frequently Asked Questions
1. Can biologic treatment usually continue around HS surgery?
Biologic therapy is usually continued for HS surgery, although your plan may vary depending on the procedure and individual health factors. You should follow the dermatologist and surgeon’s advice rather than stopping treatment yourself.
2. Will every HS procedure need a general anaesthetic?
No. You may have deroofing or another limited procedure under local anaesthetic, while a larger excision may need general anaesthetic. You can ask the surgical team which approach is planned for your procedure.
3. Why might an HS wound be left open instead of stitched?
Some HS wounds are deliberately left open so they can heal naturally from the base upwards. You can ask your surgeon why this approach is suitable and what wound care you will need during healing.
4. Could you need a skin graft or flap after wide excision?
Yes. A larger wound after wide excision may sometimes need a skin graft or flap. You can ask your surgeon whether natural healing, direct closure, grafting or a flap is more suitable for the area being treated.
5. Can surgery target one area while other HS areas are treated medically?
Yes. Surgery can treat established tunnels or scarred tissue in one area while medical treatment continues to control inflammation elsewhere. You and your dermatologist can plan both parts of treatment together.
6. Why might a multidisciplinary team be involved in HS surgery?
HS surgery may involve dermatology, surgical and wound care expertise, particularly when disease is extensive or reconstruction is needed. You may benefit from coordinated care when surgery and ongoing medical treatment need to be planned together.
7. Can surgery near the armpit affect movement during recovery?
A larger wound in the armpit can temporarily affect movement while it heals. You should ask what activity restrictions may apply and when you can safely return to your usual movement and exercise.
8. What should you know about dressings after an open HS procedure?
An open wound usually needs regular dressings to absorb drainage and protect the healing surface. You should ask what dressing to use, how often it needs changing and who to contact if wound care becomes difficult.
9. Can the scar keep changing after the wound has closed?
Yes. A surgical scar can continue to mature after the wound closes, so its appearance may change over time. You can ask your surgical team what changes are expected and when the scar should be reviewed.
10. What practical arrangements might help before you have HS surgery?
You may want to plan for dressings, comfortable clothing, time away from work and help with daily activities after your procedure. You can ask the surgical team what practical support is likely to be useful based on the wound and expected recovery.
Final Thoughts: Deciding Whether HS Surgery Is Right for You
HS surgery may be considered when you have persistent nodules, draining tunnels, abscesses or established scarring that continues to cause problems despite appropriate medical treatment. By understanding the differences between deroofing, excision and drainage, you can have a clearer discussion with your dermatologist about which approach may suit the location and extent of your disease.
If you’re looking to consult a dermatologist in London, you can get in touch with London Dermatology Centre.
References:
- Shukla, R., Karagaiah, P., Patil, A., Farnbach, K., Ortega-Loayza, A.G., Tzellos, T., Szepietowski, J.C., Giulini, M., Schepler, H., Grabbe, S. and Goldust, M. (2022) ‘Surgical treatment in hidradenitis suppurativa’, Journal of Clinical Medicine, 11(9), article 2311. Available at: https://www.mdpi.com/2077-0383/11/9/2311
- Zouboulis, C.C. et al. (2025) ‘European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment’, Journal of the European Academy of Dermatology and Venereology, 39(5), pp. 899–941. Available at: https://pubmed.ncbi.nlm.nih.gov/39699926/
- Saylor, D.K., Brownstone, N.D. and Naik, H.B. (2020) ‘Office-based surgical intervention for hidradenitis suppurativa (HS): A focused review for dermatologists’, Dermatology and Therapy, 10(4), pp. 529–549. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7367977/
- Mehdizadeh, A. et al. (2015) ‘Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis’, Journal of the American Academy of Dermatology, 73(5 Suppl 1), pp. S70–S77. Available at: https://www.sciencedirect.com/science/article/pii/S0190962215019921
- Ingram, J.R. et al. (2019) ‘British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018’, British Journal of Dermatology, 180(5), pp. 1009–1017. Available at: https://academic.oup.com/bjd/article/180/5/1009/6732702