Closing the implementation gap for HS surgery and laser therapies in the NHS- Comment on ‘The role of surgery in hidradenitis suppurativa: Expert-based holistic approaches’

Contemporary expert consensus recognises surgery as a core modality in hidradenitis suppurativa (HS), yet UK NHS delivery remains misaligned with the evidence. Deroofing and laser therapy are underused due to commissioning variability, limited dermatologic surgical capacity, and fragmented multidisciplinary care, leading to delayed source control and preventable progression. Delays in biologic initiation and limited uptake of combined medical–surgical strategies further increase morbidity despite evidence favouring integrated care. Commissioned minor-operations capacity, structured training, embedded laser pathways, and coordinated HS services are needed to reduce avoidable late-stage intervention and patient burden.