84 - Hidradenitis Suppurativa

Question 1

Hidradenitis suppurativa is otherwise known as

Answer 1

Acne inversa

Question 2

Characterized by recurrent, deep-seated, painful, subcutaneous nodules, sinus tracts, and hypertrophic scarring in the intertriginous and anogenital regions

Answer 2

Hidradenitis suppurativa

Question 3

(Men/Women) are disproportionately affected by HS

Answer 3

Women

Question 4

Women are more likely to develop _____ lesions

Answer 4

Axillary

Genitofemoral

Question 5

Men tend to develop _____ lesions

Answer 5

Perineal

Perianal

Question 6

_____ involvement is associated with a significantly worse DLQI score compared to other sites

Answer 6

Anogenital

Question 7

SCC is an infrequent complication of longstanding chronically inflamed lesions, occurring in _____% of HS cases

Answer 7

4.6

Question 8

Males with _____ are preferentially affected with SCC

Answer 8

Anogenital

Question 9

HS-associated SCC is often associated with high-risk human papillomavirus strains, most commonly

Answer 9

HPV-16

Question 10

Y/N: HS-associated SCC tends to be more locally aggressive and metastasizes to lymph nodes with greater frequency

Answer 10

Yes

Question 11

Consistent histologic finding of early HS and is thought to be the primary pathophysiologic event

Answer 11

Keratinous occlusion of the terminal hair follicle

Question 12

Y/N: Apocrine glands are primarily involved in HS

Answer 12

No - only secondarily involved

Question 13

Appears to be an early event in disease pathogenesis, preceding the onset of lymphocytic follicular inflammation and hyperkeratosis of the infundibulum

Answer 13

Sebaceous gland atrophy

Question 14

Y/N: The odds of having HS are susbstantially higher among current smokers than nonsmokers

Answer 14

Yes

Question 15

Y/N: A higher body mass index is associated with greater odds of having HS

Answer 15

Yes

Question 16

The proinflammatory cytokine, _____, is markedly elevated in HS lesions and in the serum of patients with HS

Answer 16

TNF-alpha

Question 17

_____, another potent proinflammatory cytokine, is also strikingly elevated in lesional and perilesional skin

Answer 17

IL-1beta

Question 18

Traditional bacterial cultures taken from involved sites are often negative or grow

Answer 18

Commensal skin flora

Question 19

Most frequently isolated organisms

Answer 19

Coagulase-negative staphylococus

Anaerobic bacteria

Question 20

HS is frequently associated with other diseases of follicular occlusion. The tetrad of _____ is well documented

Answer 20

HS
Acne conglobata
Dissecting cellulitis of the scalp
Pilonidal cysts

Question 21

HS is a clinical diagnosis based on 3 criteria, all of which must be present for the definitive diagnosis

Answer 21

Typical lesion (1 or more)
Typical distribution
Chronicity and recurrence

Question 22

Having _____ recurrences over a _____ period has been suggested as one measure of chronicity

Answer 22

2

6-month

Question 23

Most widely used approach to assessing disease severity

Answer 23

Hurley staging system

Question 24

Defined by recurrent abscesses without scarring or sinus tracts

Answer 24

Hurley Stage I

Question 25

Defined by recurrent abscesses with scarring and sinus tract(s), separated by normal skin

Answer 25

Hurley Stage II

Question 26

Defined by recurrent abscesses with diffuse scarring and interconnected sinus tracts with minimal to no normal skin in between lesions

Answer 26

Hurley Stage III

Question 27

Three distinct clinical phenotypes of HS

Answer 27

Axillary-mammary Follicular Gluteal

Question 28

Characterized by a predilection for follicular lesions (eg, epidermal cysts, pilonidal sinus, comedones, severe acne) and atypical topography

Answer 28

"Follicular" subtype

Question 29

Patients of the _____ subtype were more likely to be male smokers with a family history of HS and greater disease severity

Answer 29

Follicular

Question 30

Patients with the _____ subtype tend to be smokers with lower body mass indexes and more indolent disease compared to the axillary-mammary subtype

Answer 30

Gluteal

Question 31

Nonspecific but universal histopathologic finding in HS irrespective of disease duration

Answer 31

Follicular occlusion

Question 32

Secondary inflammation of the (apocrine/eccrine) glands is more often present

Answer 32

Eccrine

Question 33

Decreasing exposure to _____ may be an adjunct to medical therapy, either directly or indirectly, by promoting weight loss

Answer 33

Dairy | High-glycemic-index foods

Question 34

Active ingredient in turmeric that may help reduce inflammation via suppression of TNF-alpha

Answer 34

Curcumin

Question 35

First-line therapy

Answer 35

Clindamycin (topical) Clindamycin/rifampicin (oral) Adalimumab (subcutaneous) Tetracycline (oral)

Question 36

Second-line

Answer 36

``` Zinc gluconate Resorcinol (cream) Intralesional corticosteroid Systemic corticosteroid Infliximab Acitretin/etretinate ```

Question 37

Third-line

Answer 37

``` Colchicine Botulinum toxin (subcutaneous) Isotretinoin Dapson Cyclosporine Hormones ```

Question 38

Treatment for mild HS

Answer 38

Topical clindamycin 1% lotion BID x 12 weeks | Tetracycline 500 mg PO BID x 4 months

Question 39

Treatment for moderate HS

Answer 39

Oral clindamycin 300 mg PO BID | Rifampicin 600 mg PO daily x 10 weeks

Question 40

Mainstays of management of mild-to-moderate HS

Answer 40

Topical and oral antibiotic therapy

Question 41

Largely ineffective for HS but are still commonly prescribed

Answer 41

Topical tretinoin | Oral isotretinoin

Question 42

Cornerstone for managing chronic HS

Answer 42

Excisional surgery

Question 43

Nonspecific but universal histopathologic finding in HS irrespective of disease duration

Answer 43

Follicular occlusion

Question 44

Secondary inflammation of the (apocrine/eccrine) glands is more often present

Answer 44

Eccrine

Question 45

Decreasing exposure to _____ may be an adjunct to medical therapy, either directly or indirectly, by promoting weight loss

Answer 45

Dairy | High-glycemic-index foods

Question 46

Active ingredient in turmeric that may help reduce inflammation via suppression of TNF-alpha

Answer 46

Curcumin

Question 47

First-line therapy

Answer 47

Clindamycin (topical) Clindamycin/rifampicin (oral) Adalimumab (subcutaneous) Tetracycline (oral)

Question 48

Second-line

Answer 48

``` Zinc gluconate Resorcinol (cream) Intralesional corticosteroid Systemic corticosteroid Infliximab Acitretin/etretinate ```

Question 49

Third-line

Answer 49

``` Colchicine Botulinum toxin (subcutaneous) Isotretinoin Dapson Cyclosporine Hormones ```

Question 50

Treatment for mild HS

Answer 50

Topical clindamycin 1% lotion BID x 12 weeks | Tetracycline 500 mg PO BID x 4 months

Question 51

Treatment for moderate HS

Answer 51

Oral clindamycin 300 mg PO BID | Rifampicin 600 mg PO daily x 10 weeks

Question 52

Mainstays of management of mild-to-moderate HS

Answer 52

Topical and oral antibiotic therapy

Question 53

Largely ineffective for HS but are still commonly prescribed

Answer 53

Topical tretinoin | Oral isotretinoin

Question 54

Cornerstone for managing chronic HS

Answer 54

Excisional surgery