CC Sept 2017 Hidradenitis suppurativa

echoecho's version from 2018-04-30 00:14


Question Answer
Another name for hidradenitis suppurativa (HS)?Acne inversa
Acne inversa comes from what Greek word?Hydra = sweat, Aden= glands
It was thought that the skin lesions arose from the apocrine glands, however, it is now felt that the pathogenesis is what?Plugging of follicles, followed by follicle rupture and subsequent inflammation
What is the prevalence of HS?1-4%
Onset is usually seen in what decades? Can it occur before puberty?Second and third decades; rarely
What gender is more commonly affected?Women (3:1)
List the skin conditions that are commonly associated with HS?1) acne vulgaris 2) pilonidal cyst 3) acne con Global a
What is acne conglobata?Severe form of acne found particularly in males where scarring nad keloid formation are frequent sequelae
HS is also associated with what conditions?1) obesity 2) metabolic syndrome 3) tobacco smoking 4) Crohn's disease
What 2 factors also play a role in the pathogenesis of HS?1) genetic factors 2) environmental factors
List the primary site in women?1) axillae 2) inguinal, upper thigh 3) mammary and inframammary areas
List the primary sites in men?1) axillae 2) inguinal upper thigh 3) buttocks, gluteal cleft 4) perinatal 5) perineum
List other sites found in men and women/1) nuchal scalp 2) retroauricular 3) scrotum
What part of the body is the most common site of HS?Axillae
What other areas can be affected?Those where there is skin compression and friction (belt lines and waist bands)
The primary lesion of HS is what?An inflammatory nodule that is usually deep-seated, painful and located in an intertriginous area than can last days to months
*** The early lesions of HS are often misdiagnosed as being what?Furuncles
*** What are the differentiating characteristics between HS and furuncles?1) deep location 2) rounded appearance 3) absence of local lymph node involvement
The lesions can become super infected, although what 2 bacteria (common in furuncles), are rarely involved in HS?1) streptococci 2) staphylococcus aureus
Unlike furuncles, HS lesions do not rupture centrally and drain, but rather open ______?Laterally
'Recurrences can occur in the same location or the same area, often with multiple lesions developing, true or false?True
Lesions can progress with the development of _____ tracts, often communicating between multiple nodules or with the surface of the skin?Sinus
Seropurulent or malodorous blood discharge can be present, cultures are frequently _____?Negative
If the disease progresses, there can be ______ and fibrous bands in addition to sinus tracts?Scarring
*** The diagnosis is a clinical one based on what 3 things?1) appearance 2) recurrences 3) characteristic distribution
Describe folliculitis in comparison with HS?1) more superficial lesion 2) not painful
Describe cellulitis and erysipelas compared to HS?Produce more diffuse redness and would not result in nodules
List the Hurley clinical staging system which divides HS into what 3 groups based on severity?1) stage I = single or multiple abscesses, but no sinus tracts or scarring 2) stage II = single or multiple separated, recurrent abscesses with tract formation and scarring 3) stage III = multiple interconnected tracts and abscesses involving an entire anatomical area
Because of the chronic, recurrent nature of HS it can be a _______ disease, particularly in the more advanced stages?Debilitating
The lesions are painful and if there is scarring, there can be what?restriction of motion (restriction of arm motion with axillary involvement
The appearance of the skin can cause what?1) social isolation 2) involvement of genital area can impair sexual health and activity
The _______ drainage from the sinus tracts can cause embarrassment and add to social isolation?malordorous
Is depression common?yes
What cancer is a rare complication of longstanding skin lesions?squamous cell carcinoma
For all of the above reasons, ______ diagnosis and appropriate treatment is important?early
While early-stage disease responds reasonably well to therapy, does later-stage disease does the same?no
*** What 2 preventive things can one do as general treatment measures, even though there are no studies linking these 2 measures w/ symptom improvement?1) cessation of tobacco smoking 2) weight loss
Daily, gentle hygiene of affected areas and avoiding skin trauma including tight, occlusive clothing is recommended, what is not recommended?1) chlohexidine 2) aseptic washes 3) bacterial swabs 4) not recommended is scrubbing of the skin when washing and using adherent bandages
*** What is the first line treatment for mild (stage I and early stage II) disease? Do studies demonstrate significant benefit over placebo?1) topical clindamycin 1% applied BID for 3 months 2) yes
Topical _______ 15% cream, an exfoliant used once or twice daily during flares, has been shown to reduce pain and duration of abscesses?Resorcinol
What treatment can help speed resolution of early lesions and decrease pain?intralesional corticosteroids
What type of debridement can be used to essentially excise the inflammatory nodule and the associated folliculopilosebaceous unit?punch debridement using 5-7 mm punch biopsy instrument
When are antibiotics used? Which antibiotics are used?1) indicated for stage II disease or milder cases not responsive to therapy 2) Doxycycline (Doryx) 50-100 mg BID or Minocycline (Minocin) 50-100 mg BID are recommended and typically need to be continued for several months. 3) Second line therapy for those who do not respond to first line therapy is a combination of Clinidmycin (Cleocin) 300 mg BID and Rifampin 600 mg daily in 1 or 2 doses. 4) Other agents includ Dapsone; the combination of metronidazole, moxifloxacin and rifampin and antiandrogens
What treatment is used for severe disease (stage III)?surgery (although it doesn't affect the underlying disease process)
In addition to punch debridement, what other procedures can be done for stage III?1) curetting and excision of individual lesions 2) deroofin of the lesions 3) total excision of the lesions and surrounding hair bearing skin
What medications can be used but the response is not as robust or consistent as w/ acne vulgaris in stage III?oral retinoids
Why can't retinoids be used in women who may become pregnant?because they are teratogenic (preg categor X)
What medication is approved for the treatment HS, using the initial dose of 160 mg, followed by 80 mg 2 weeks later and then 40 weekly starting on day 29? What is the response?Adalimumab (humira) 2) response is partial w/ a decrease in total abscess and inflammatory nodule count but no change in draining abscess and fistula count
Infliximab (Remicade) has shown to offer some benefit in trials but is not approved for the treatment of HS, true or false?true
Comment on Adalimumab (Humira) and Infliximab (Remicade) in regards to the effect of the agents on lesions? What must be discussed fully with patients?1) effect of both of these agents stops w/ discontinuation of therapy 2) the adverse effects must be discussed fully with patients
List the meds that are studies are underway for?1) ustkinumab (Stelara), an interleukin (IL)-12/23 inhibitor 2) anakinra (Kineret), an antagonist of the IL-1 receptor and 3) tacrolimus (Prograf), a calcineurin inhibitor
*** SUMMARY = HS is a chronic, painful, potentially disfiguring and debilitating disease involving occluded _____ ______?hair follicles
*** SUMMARY = Most common areas of involvement are what?1) axillae 2) distribution of lesions varies depending on the sex of the patient
*** SUMMARY = What other conditions are associated with HS?1) obesity 2) metabolic syndrome 3) tobacco smoking 4) Crohn's disease
*** SUMMARY = Treatment of later-stage, more advanced disease is easy, true or false?false, it is difficult