84 - Hidradenitis Suppurativa Flashcards
Hidradenitis suppurativa is otherwise known as
Acne inversa
Characterized by recurrent, deep-seated, painful, subcutaneous nodules, sinus tracts, and hypertrophic scarring in the intertriginous and anogenital regions
Hidradenitis suppurativa
(Men/Women) are disproportionately affected by HS
Women
Women are more likely to develop _____ lesions
Axillary
Genitofemoral
Men tend to develop _____ lesions
Perineal
Perianal
_____ involvement is associated with a significantly worse DLQI score compared to other sites
Anogenital
SCC is an infrequent complication of longstanding chronically inflamed lesions, occurring in _____% of HS cases
4.6
Males with _____ are preferentially affected with SCC
Anogenital
HS-associated SCC is often associated with high-risk human papillomavirus strains, most commonly
HPV-16
Y/N: HS-associated SCC tends to be more locally aggressive and metastasizes to lymph nodes with greater frequency
Yes
Consistent histologic finding of early HS and is thought to be the primary pathophysiologic event
Keratinous occlusion of the terminal hair follicle
Y/N: Apocrine glands are primarily involved in HS
No - only secondarily involved
Appears to be an early event in disease pathogenesis, preceding the onset of lymphocytic follicular inflammation and hyperkeratosis of the infundibulum
Sebaceous gland atrophy
Y/N: The odds of having HS are susbstantially higher among current smokers than nonsmokers
Yes
Y/N: A higher body mass index is associated with greater odds of having HS
Yes
The proinflammatory cytokine, _____, is markedly elevated in HS lesions and in the serum of patients with HS
TNF-alpha
_____, another potent proinflammatory cytokine, is also strikingly elevated in lesional and perilesional skin
IL-1beta
Traditional bacterial cultures taken from involved sites are often negative or grow
Commensal skin flora
Most frequently isolated organisms
Coagulase-negative staphylococus
Anaerobic bacteria
HS is frequently associated with other diseases of follicular occlusion. The tetrad of _____ is well documented
HS
Acne conglobata
Dissecting cellulitis of the scalp
Pilonidal cysts
HS is a clinical diagnosis based on 3 criteria, all of which must be present for the definitive diagnosis
Typical lesion (1 or more)
Typical distribution
Chronicity and recurrence
Having _____ recurrences over a _____ period has been suggested as one measure of chronicity
2
6-month
Most widely used approach to assessing disease severity
Hurley staging system
Defined by recurrent abscesses without scarring or sinus tracts
Hurley Stage I
Defined by recurrent abscesses with scarring and sinus tract(s), separated by normal skin
Hurley Stage II
Defined by recurrent abscesses with diffuse scarring and interconnected sinus tracts with minimal to no normal skin in between lesions
Hurley Stage III
Three distinct clinical phenotypes of HS
Axillary-mammary
Follicular
Gluteal
Characterized by a predilection for follicular lesions (eg, epidermal cysts, pilonidal sinus, comedones, severe acne) and atypical topography
“Follicular” subtype
Patients of the _____ subtype were more likely to be male smokers with a family history of HS and greater disease severity
Follicular
Patients with the _____ subtype tend to be smokers with lower body mass indexes and more indolent disease compared to the axillary-mammary subtype
Gluteal
Nonspecific but universal histopathologic finding in HS irrespective of disease duration
Follicular occlusion
Secondary inflammation of the (apocrine/eccrine) glands is more often present
Eccrine
Decreasing exposure to _____ may be an adjunct to medical therapy, either directly or indirectly, by promoting weight loss
Dairy
High-glycemic-index foods
Active ingredient in turmeric that may help reduce inflammation via suppression of TNF-alpha
Curcumin
First-line therapy
Clindamycin (topical)
Clindamycin/rifampicin (oral)
Adalimumab (subcutaneous)
Tetracycline (oral)
Second-line
Zinc gluconate Resorcinol (cream) Intralesional corticosteroid Systemic corticosteroid Infliximab Acitretin/etretinate
Third-line
Colchicine Botulinum toxin (subcutaneous) Isotretinoin Dapson Cyclosporine Hormones
Treatment for mild HS
Topical clindamycin 1% lotion BID x 12 weeks
Tetracycline 500 mg PO BID x 4 months
Treatment for moderate HS
Oral clindamycin 300 mg PO BID
Rifampicin 600 mg PO daily x 10 weeks
Mainstays of management of mild-to-moderate HS
Topical and oral antibiotic therapy
Largely ineffective for HS but are still commonly prescribed
Topical tretinoin
Oral isotretinoin
Cornerstone for managing chronic HS
Excisional surgery
Nonspecific but universal histopathologic finding in HS irrespective of disease duration
Follicular occlusion
Secondary inflammation of the (apocrine/eccrine) glands is more often present
Eccrine
Decreasing exposure to _____ may be an adjunct to medical therapy, either directly or indirectly, by promoting weight loss
Dairy
High-glycemic-index foods
Active ingredient in turmeric that may help reduce inflammation via suppression of TNF-alpha
Curcumin
First-line therapy
Clindamycin (topical)
Clindamycin/rifampicin (oral)
Adalimumab (subcutaneous)
Tetracycline (oral)
Second-line
Zinc gluconate Resorcinol (cream) Intralesional corticosteroid Systemic corticosteroid Infliximab Acitretin/etretinate
Third-line
Colchicine Botulinum toxin (subcutaneous) Isotretinoin Dapson Cyclosporine Hormones
Treatment for mild HS
Topical clindamycin 1% lotion BID x 12 weeks
Tetracycline 500 mg PO BID x 4 months
Treatment for moderate HS
Oral clindamycin 300 mg PO BID
Rifampicin 600 mg PO daily x 10 weeks
Mainstays of management of mild-to-moderate HS
Topical and oral antibiotic therapy
Largely ineffective for HS but are still commonly prescribed
Topical tretinoin
Oral isotretinoin
Cornerstone for managing chronic HS
Excisional surgery
