Minimally invasive approach for hidradenitis suppurativa shows promise

Dr. Irena Pastar and Dr. Hadar Lev-Tov. Photo courtesy Miller School of Medicine

Physicians at the University of Miami Miller School of Medicine are reporting encouraging results from a new, minimally invasive procedure to treat hidradenitis suppurativa (HS).

The study, led by Dr. Hadar Lev-Tov, associate professor in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and medical director of the Miami HS Center, tested whether antimicrobial wound-healing strategies could be applied to chronic HS lesions (recurrent nodules, abscesses, and tunnelling in sinus tracts). The findings, published in the Journal of the American Academy of Dermatology, suggest the approach may offer faster healing and fewer complications than conventional surgery.

HS typically appears at puberty and disproportionately affects women and minority populations. Its pathophysiology remains incompletely understood, but microbial dysbiosis and biofilm formation are increasingly recognized as central to its persistence. Current treatments often rely on extensive excision—procedures that are associated with scarring, impaired mobility, and frequent recurrence.

“Our thinking was to treat the HS tunnels like an under-skin wound,” Dr. Lev-Tov said in a press release. “If I can restore the normal skin microbiome or even completely remove the bacteria, then I can promote normal healing and potentially resolve the HS tunnels without the scarring and other complications.”

The pilot trial included 15 patients at the Miami HS Center. Each underwent a punch incision at the beginning and end of a tunnel under local anesthesia, followed by administration of an antimicrobial gel delivered via a syringe and catheter. Patients were discharged the same day and taught to continue self-application at home.

According to the investigators, lesions healed in less than 12 days on average, with a 93% resolution rate. Microbiome analysis showed a reduction in pathogenic bacteria and a shift toward healthier skin flora, with corresponding decreases in local inflammatory markers. “Analyzing the microbiome and tissue inflammation before and after procedure, my laboratory revealed a major drop in harmful bacteria and a shift toward a healthier, more balanced microbiome,” said Dr. Irena Pastar, research professor and senior author.

Importantly, participants reported improved quality of life, with many opting to forgo excisional surgery altogether. Dr. Pastar emphasized that the therapy does not pose the risk of antibiotic resistance development that can often complicate chronic dermatologic infections.

The study was limited by its single-arm design and small sample size. Only one tunnel per patient was treated, leaving questions about efficacy in patients with more extensive disease. Larger, controlled trials are planned, including assessments of combination approaches with systemic biologics.

The Miami team believes their results signal a potential paradigm shift for this difficult-to-treat disease. “We found that, on average, patients healed in less than 12 days … with a reduced bacterial load. Patients reported an improved quality of life without significant adverse effects,” Dr. Lev-Tov noted.