Dermatology Flashcards
What is the most significant prognostic factor for melanoma?
Breslow depth (tumor depth measured in millimeters).
Other prognostic factors for melanoma besides Breslow depth:
- Ulceration
- Sentinel lymph node involvement
- Lymphovascular invasion
- Mitotic rate
What are the clinical features of melanoma?
Asymmetry.
Border irregularity.
Color variability.
Diameter >6 mm.
Evolution over time.
A patient with a history of diabetes who has had chronic lesions under axilla, breasts or in gluteal clefts. Physical exam shows nodules, cysts, comedones, and scarring. What is the diagnosis?
Hidradenitis suppurativa, also called acne inversa, a chronic inflammatory skin condition affecting intertriginous areas.
What is the pathophysiology of hidradenitis suppurativa?
Chronic inflammation of folliculopilosebaceous units, leading to follicular occlusion, rupture, and secondary bacterial infection.
What are the characteristic clinical features of hidradenitis suppurativa?
Painful nodules, cysts, abscesses, comedones, sinus tracts, and scarring in intertriginous areas such as the axillae, breasts, inguinal folds, and gluteal clefts. Can be complicated by rope-like scarring, abscess, or draining sinus tracts formation.
Which anatomical areas are most commonly affected in hidradenitis suppurativa?
Intertriginous areas: axillae, breasts, inguinal folds, perineum, and gluteal clefts.
What are the key risk factors for hidradenitis suppurativa?
Obesity, diabetes mellitus, smoking, metabolic syndrome, and family history.
How is hidradenitis suppurativa diagnosed?
Clinically.
When is incision and drainage indicated for hidradenitis suppurativa?
Only for acute, fluctuant abscesses. It is not effective for chronic disease.
What is the role of surgery in hidradenitis suppurativa?
Intralesional steroids or surgical unroofing is done to decrease inflammation in acute, symptomatic lesions. Wide surgical excision is indicated in severe, refractory cases to remove affected tissue in cases of chronic disease.
What are the three stages of hidradenitis suppurativa according to the Hurley classification?
Stage I: Isolated nodules/abscesses with no sinus tracts or scarring.
Stage II: Recurrent abscesses with sinus tract formation and scarring.
Stage III: Diffuse involvement with interconnected sinus tracts and extensive scarring.
What is the first-line treatment for mild hidradenitis suppurativa (Hurley stage I)?
Lifestyle modifications (e.g., weight loss, smoking cessation, avoidance of trauma). Topical clindamycin.
Why is smoking cessation recommended for patients with hidradenitis suppurativa?
Smoking worsens follicular occlusion and increases disease severity.
What is the treatment for moderate hidradenitis suppurativa (Hurley stage II)?
Oral tetracyclines (e.g., doxycycline) or clindamycin + rifampin combination therapy.
What is the treatment for severe hidradenitis suppurativa (Hurley stage III)?
Biologic therapy (adalimumab) or surgical excision of affected skin.
What systemic medications can be used in severe hidradenitis suppurativa?
TNF-alpha inhibitors (e.g., adalimumab), oral retinoids, and cyclosporine.
What is the relationship between hidradenitis suppurativa and metabolic syndrome?
HS is strongly associated with insulin resistance, obesity, dyslipidemia, and hypertension.
What psychological comorbidities are associated with hidradenitis suppurativa?
Depression and anxiety due to chronic pain, disfigurement, and social stigma.
