Commentary on response to remission of hidradenitis suppurativa after bariatric surgery

To the Editor: We are grateful to Dr Golbari and colleagues from the Stony Brook University School of Medicine for their interest in our recently published article.¹

Our article describes 2 cases in which our patients' hidradenitis suppurativa (HS) resolved after bariatric surgery, whereas, in contrast, Golbari et al used online forums, which found that most had worsening symptoms caused by an increase in skin folds. These data are interesting, as many of our patients report their use of online forums to share disease experiences. Of course frictional sites share a predilection for HS, but of note neither of our patients required abdominoplasty for removal of excess skin. Golbari et al also comment on obstacles related to insurance coverage for removal of excess skin after surgery, another interesting point, as it was not something we alluded to in our article because insurance would not be as big an issue encountered in our Irish Health System.

We agree that our patients should be counselled that surgery will not necessarily improve their symptoms; however, we do not feel this should deter patients from such surgery, as weight loss has other benefits, such as improvement in metabolic indices, which we found in our cases, resulting in not only cutaneous benefits but improvement in overall cardiovascular health.

Their commentary highlights the heterogeneity of patients with HS and reiterates that HS is a difficult disease to treat with not one therapy working for every individual. It is clear that further clinical data and open label trials are required to assess the utility of bariatric surgery in HS.