Yes, this is hidradenitis suppurativa, and surgical consultation is absolutely appropriate for this patient.
Diagnosis Confirmation
Your patient meets all three diagnostic criteria for hidradenitis suppurativa (HS): recurrent painful nodules/abscesses with sinus tracts in typical locations (groin, inner thigh), chronic course (>1 year), and characteristic findings of skin tethering, thickening, and fistulous tracts 1. The bilateral involvement (right thigh lesions with left groin lesions) and absence of axillary disease represents a common phenotypic variation—HS does not require involvement of all typical sites 1.
The year-long recurrent pattern following incision and drainage is pathognomonic, as simple incision and drainage has a nearly 100% recurrence rate in HS 2. This patient's clinical course perfectly illustrates why I&D alone fails in HS management.
Why Surgical Consultation is Indicated Now
Surgical referral should be obtained because:
- Presence of sinus tracts/fistulous tracts indicates at least Hurley Stage II disease, which benefits from surgical intervention 2, 1
- The skin tethering and thickening suggest established fibrosis and chronic disease that will not respond adequately to medical therapy alone
- Deroofing procedures have 90% patient satisfaction with only 4-17% recurrence rates, vastly superior to the repeated I&D this patient has endured 2
- Medical therapy (doxycycline) should continue but is insufficient as monotherapy for established structural disease with sinus tracts
Surgical Options to Discuss
The surgeon should consider:
- Deroofing technique: Probing and removing skin overlying sinus tracts while leaving the base intact—this is the preferred approach for localized disease with sinus tracts and can be performed in outpatient settings 2
- Wide local excision: Reserved for more extensive disease, though this carries higher morbidity and requires careful discussion of reconstruction options 2
- Staged procedures if bilateral involvement requires treatment
Critical caveat: Groin and medial thigh locations have higher recurrence rates than other anatomical sites, so realistic expectations about outcomes must be set 2.
Concurrent Medical Management
Continue doxycycline as it provides anti-inflammatory benefits beyond simple antibiotic effects 3. However, recognize that antibiotics alone will not eliminate established sinus tracts and fibrotic tissue—these require physical removal 2.
Address modifiable risk factors: smoking cessation (if applicable), weight optimization if BMI elevated, and screening for associated comorbidities including metabolic syndrome, depression, and inflammatory bowel disease 1.
Common Pitfall to Avoid
Do not continue repeated incision and drainage procedures—this approach has failed your patient for over a year and will continue to fail 2. Each I&D cycle causes additional trauma, inflammation, and potentially worsens scarring without addressing the underlying sinus tract pathology. The surgical consultation should emphasize definitive procedures (deroofing or excision) rather than temporizing drainage.