Deroofing: A Practical Guide for the Dermatologist

Purpose of Review Hidradenitis suppurativa is a chronic inflammatory skin condition marked by significant structural changes such as nodules, abscesses, and subcutaneous tunnels, often accompanied by drainage and pain. Medical treatment alone usually does not suffice for optimal disease control. Therefore, surgical interventions, particularly for moderate-to-severe cases with tunnel formation, are a crucial adjunct to medical therapy. This paper aims to outline a practical approach to deroofing in hidradenitis suppurativa, covering the necessary materials, surgical approach, wound care, common complications, and frequent patient questions. Recent Findings Classically, wide excision of the entire anatomical area affected by hidradenitis suppurativa is performed in the operating room under general anesthesia. As a tissue-sparing alternative, deroofing—excision of tunnels—can be performed in-office under local anesthesia. This method allows for targeted application to either single lesions or entire anatomic regions, preserving the base of the cavity. Post-surgical wounds are typically left to heal by secondary intention. Summary Deroofing is a safe, in-office procedure for the management of hidradenitis suppurativa, with minimal rates of post-surgical complications. It is generally well-tolerated and associated with high patient satisfaction. When combined with proper medical treatment, deroofing can help patients achieve local disease control. Optimizing post-operative wound care is paramount to facilitate patient recovery.