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Fitz 9th > 84 - Hidradenitis Suppurativa > Flashcards

84 - Hidradenitis Suppurativa Flashcards

1
Q

Hidradenitis suppurativa is otherwise known as

A

Acne inversa

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2
Q

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

A

Hidradenitis suppurativa

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3
Q

(Men/Women) are disproportionately affected by HS

A

Women

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4
Q

Women are more likely to develop _____ lesions

A

Axillary

Genitofemoral

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5
Q

Men tend to develop _____ lesions

A

Perineal

Perianal

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6
Q

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

A

Anogenital

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7
Q

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

A

4.6

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8
Q

Males with _____ are preferentially affected with SCC

A

Anogenital

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9
Q

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

A

HPV-16

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10
Q

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

A

Yes

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11
Q

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

A

Keratinous occlusion of the terminal hair follicle

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12
Q

Y/N: Apocrine glands are primarily involved in HS

A

No - only secondarily involved

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13
Q

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

A

Sebaceous gland atrophy

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14
Q

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

A

Yes

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15
Q

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

A

Yes

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16
Q

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

A

TNF-alpha

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17
Q

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

A

IL-1beta

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18
Q

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

A

Commensal skin flora

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19
Q

Most frequently isolated organisms

A

Coagulase-negative staphylococus

Anaerobic bacteria

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20
Q

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

A

HS
Acne conglobata
Dissecting cellulitis of the scalp
Pilonidal cysts

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21
Q

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

A

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

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22
Q

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

A

2

6-month

23
Q

Most widely used approach to assessing disease severity

A

Hurley staging system

24
Q

Defined by recurrent abscesses without scarring or sinus tracts

A

Hurley Stage I

25
Q

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

A

Hurley Stage II

26
Q

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

A

Hurley Stage III

27
Q

Three distinct clinical phenotypes of HS

A

Axillary-mammary
Follicular
Gluteal

28
Q

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

A

“Follicular” subtype

29
Q

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

A

Follicular

30
Q

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

A

Gluteal

31
Q

Nonspecific but universal histopathologic finding in HS irrespective of disease duration

A

Follicular occlusion

32
Q

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

A

Eccrine

33
Q

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

A

Dairy

High-glycemic-index foods

34
Q

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

A

Curcumin

35
Q

First-line therapy

A

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

36
Q

Second-line

A 
Zinc gluconate
Resorcinol (cream)
Intralesional corticosteroid
Systemic corticosteroid
Infliximab
Acitretin/etretinate
37
Q

Third-line

A 
Colchicine
Botulinum toxin (subcutaneous)
Isotretinoin
Dapson
Cyclosporine
Hormones
38
Q

Treatment for mild HS

A

Topical clindamycin 1% lotion BID x 12 weeks

Tetracycline 500 mg PO BID x 4 months

39
Q

Treatment for moderate HS

A

Oral clindamycin 300 mg PO BID

Rifampicin 600 mg PO daily x 10 weeks

40
Q

Mainstays of management of mild-to-moderate HS

A

Topical and oral antibiotic therapy

41
Q

Largely ineffective for HS but are still commonly prescribed

A

Topical tretinoin

Oral isotretinoin

42
Q

Cornerstone for managing chronic HS

A

Excisional surgery

43
Q

Nonspecific but universal histopathologic finding in HS irrespective of disease duration

A

Follicular occlusion

44
Q

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

A

Eccrine

45
Q

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

A

Dairy

High-glycemic-index foods

46
Q

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

A

Curcumin

47
Q

First-line therapy

A

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

48
Q

Second-line

A 
Zinc gluconate
Resorcinol (cream)
Intralesional corticosteroid
Systemic corticosteroid
Infliximab
Acitretin/etretinate
49
Q

Third-line

A 
Colchicine
Botulinum toxin (subcutaneous)
Isotretinoin
Dapson
Cyclosporine
Hormones
50
Q

Treatment for mild HS

A

Topical clindamycin 1% lotion BID x 12 weeks

Tetracycline 500 mg PO BID x 4 months

51
Q

Treatment for moderate HS

A

Oral clindamycin 300 mg PO BID

Rifampicin 600 mg PO daily x 10 weeks

52
Q

Mainstays of management of mild-to-moderate HS

A

Topical and oral antibiotic therapy

53
Q

Largely ineffective for HS but are still commonly prescribed

A

Topical tretinoin

Oral isotretinoin

54
Q

Cornerstone for managing chronic HS

A

Excisional surgery

Fitz 9th (108 decks)

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