Pain Outcomes after Surgical Excision in Hidradenitis Suppurativa and the Role of Ultrasonography

BACKGROUND: Pain is an important clinical feature of hidradenitis suppurativa (HS) and contributes substantially to disease burden, yet pain outcomes after surgical excision remain insufficiently characterized. OBJECTIVE: The aim of this study was to quantify pain reduction after surgical excision and explore factors associated with residual postoperative pain, including ultrasonographic findings. PATIENTS AND METHODS/MATERIALS: The authors retrospectively evaluated consecutive patients undergoing local excision at a tertiary dermatologic surgery unit from May 2024 to May 2025. Pain was assessed by Visual Analog Scale (VAS) before surgery and at 6 months. Tunnel extent was measured by palpation and high-frequency ultrasonography. RESULTS: Eighty-three patients with 194 lesions were included. The mean VAS decreased from 6.9 to 0.9 (mean difference, 6.0; 95% CI, 5.8-6.2; p < .001), with greater absolute reductions in advanced disease. Ultrasonographic-palpation discrepancy showed a weak positive correlation with postoperative pain (Spearman ρ = 0.19; p = .007) and remained significant in multivariable analysis. Ultrasonographic tunnel length was not associated with pain outcomes. CONCLUSION: Surgical excision was associated with substantial pain reduction across HS severity levels. The ultrasonographic-palpation discrepancy showed only a weak association with residual postoperative pain and should be considered a secondary, exploratory finding rather than an individual predictor of outcome.