CLINICAL CHALLENGE Deroofing is an in -office technique for hidradenitis suppurativa that is typically locally curative for the specific lesion treated. It is a superior option over incision and drainage, due to lower recurrence rates (100% for incision and drainage vs 4%-19% for deroofing), minimal complications, and high patient satisfaction. 1 Conventional deroofing typically entails administering local anesthesia, removing the roof of each abscess/ tunnel and exposing all interconnected cavities using scalpel, scissors, electrosurgery, or a CO 2 laser. 2 Punch debridement, also called mini-deroofing, is a simpler technique suitable for managing small abscesses or tunnels and requiring the same skillset as a punch biopsy. 2 However, many providers remain unaware of this treatment option and the technique. SOLUTION Here, we provide a simple video demonstrating the punch debridement technique and required tools for the treatment of hidradenitis suppurativa (Video 1, available on www.jaad.org). Following local anesthesia, a 5 -to8 -mm circular disposable biopsy punch is used to access the cavity and release any drainage. Then, a curettage or grattage, using gauze wrapped around a cotton swab, is utilized to debride the cavity lining. Hemostasis is accomplished with aluminum chloride. Healing occurs by secondary intention, and wound care with petrolatum and bandages is typically recommended for 4 to 8 weeks. While the recurrence rate following punch debridement has not been studied specifically, it is likely similar to deroofing, making it a simple and effective technique. This procedure's simplicity allows for easy adaptation from dermatology or primary care clinics to the emergency department, with the potential to supplant incision and drainage with a more effective procedure.
