Deroofing is a surgical procedure that involves the removal of the “roofs” and inflamed debris from hidradenitis suppurativa (HS) lesions so that they can heal.

HS is a chronic skin condition characterized by painful, inflamed nodules and sinus tracts. There’s not yet a cure for this condition, but there are various treatments that can help you manage it.

Deroofing is among the most common surgeries for HS, alongside drainage and minor incisions. It has a relatively high success rate, but there are some potential drawbacks to be aware of.

Noninvasive methods like taking antibiotics or biologics may help, but surgery is often necessary for recurring lesions. Options range from minor interventions like deroofing to major ones like wide excision. Here’s what to know about deroofing.

Deroofing is a fairly simple, minimally invasive surgery that involves the removal of the top layer of skin at the inflamed sinus sites or lesions of HS.

The process usually involves a surgeon:

  1. injecting the treatment area with lidocaine or another local anesthetic
  2. using a probe to remove the “roof”, or top layer of skin, of the targeted lesions or sinus tracts
  3. using a scalpel, scissors, or an electrocautery tool to remove all inflamed pus or debris
  4. applying ferric chloride/aluminum chloride and petroleum jelly to the new wound
  5. applying gauze
  6. educating you on wound care, which will involve gentle daily cleansings with soap and water and regularly applying fresh gauze

You’ll then need to allow the infected area to heal naturally.

Deroofing is considered an effective way to treat mild to moderate HS.

According to 2022 research, the rate of treated lesions returning after deroofing or excision is anywhere from less than 5% to 25%. Currently, these two methods are the most effective at eliminating chronic lesions. While excision is typically the preferred method for severe HS outbreaks, deroofing is most effective for mild to moderate lesions.

By contrast, incision and drainage surgeries do effectively remove inflamed material and relieve acute pain, but they don’t necessarily prevent reoccurrence.

In the same 2022 study, the researchers found that only about 17% of deroofed lesions reoccurred after 5 months. And over 80% of deroofed lesions were still gone after a 34-month follow-up.

Although more data is needed, reoccurrence and complication rates for deroofing also seem to be lower than those for excision.

Even though deroofing is among the most effective options for long-term HS lesion removal, it does have some potential disadvantages, including the following.


Deroofing has a complication rate of about 12.5%. Potential side effects do tend to be mild though. They can include:

Deroofing still carries a lower complication rate than more invasive options. For reference, excision has a complication rate of about 26%. Complications from excision also tend to be more serious.


Most people report some pain during the surgery and during recovery. According to the 2022 research above, participants said they experienced mild pain during the operation and mild to moderate pain 1 week after the operation.

However, the benefits may outweigh the pain. Over 75% of people found their recovery pain to be about the same or less intense than typical HS-related pain during flare-ups.


Again, a deroofing procedure doesn’t guarantee that HS outbreaks will be gone for good. Up to a quarter of lesions may reoccur in the months and years following the operation.

Still, since there’s not yet a cure for HS, the surgery is currently one of the most effective methods for removing lesions in the long term.

It’s also worth noting that researchers have found reoccurrence rates to be much lower with a combination of deroofing, antibiotics, and biologics.

Recovering from a deroofing procedure is relatively quick and simple. You can return home on the day of the operation, and you should be able to take less than a week away from work or school to recover. In the 2022 study, researchers found that people missed roughly 2 days of work or school for the operation and their recovery.

You can expect to return to your regular activities, including physical exercise, within 2 weeks. In the 2022 study, people needed 3–14 days to return to their typical activities.

In general, complete healing of the deroofed lesions should happen within 4–5 weeks. During this time, it’s important to follow your dermatologist’s instructions to aid in the wound healing process. You’ll need to regularly clean and dress your wounds to help with your healing.

There’s not yet a cure for HS, but deroofing is one of the most effective ways to treat chronic lesions. The minimally invasive surgery involves taking the “roofs” off lesions and allowing them to heal naturally after the operation.

Deroofing does come with some risk of reoccurring lesions, pain at the wound sites, and complications like scarring.

If you need support treating your HS, you can talk with a doctor about your options.