Hidradenitis Suppurativa: Diagnosis and Management
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Identify which body areas to focus on during the physical exam for hidradenitis suppurativa 2. Discuss treatment options that may alleviate the symptoms of hidradenitis suppurativa
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Hidradenitis suppurativa (HS), also known as acne inversa (AI) is a chronic, recurrent inflammatory disease of the apocrine sweat glands located in the axillae, groin, genitals, perineal and perianal regions, buttocks, and infra- and intermammary areas. Women are affected more often than men, and the disease is more common among African Americans
Ask about a history of chronic/recurrent abscesses with postpubertal onset
On physical exam, look for
Tender symmetric, multiple deep inflamed intertriginous lesions
Abscesses, sinus tracts and scarring in more advanced cases
Use the Hurley system for staging
Stage 0: No active HS
Stage I: Localized abscess, no sinus tracts
Stage II: Recurrent abscesses with sinus tracts, scarring, single or multiple widely separated lesions
Stage III: Diffuse involvement, multiple interconnected sinus tracts and abscesses
Cultures of lesions are sterile or grow mixed flora
HS is a chronic relapsing inflammatory disease of the apocrine glands (folliculopilosebaceous units). Multiple factors including genetic, immunological, behavioral and endocrine are possible underlying mechanisms. The impact of the disease on self-esteem and quality of life can be severe, thus the importance of early diagnosis and treatment. While some of the treatments for more severe cases outlined below will be beyond the scope of a general women’s health practice, the use of antibiotics and oral contraceptives along with lifestyle changes and patient education can limit and/or reduce outbreaks.
Weight loss if overweight or obese, smoking cessation, avoidance of tight-fitting, restrictive clothing
Chlorhexidine, peroxides, and permanganate soaks are sometimes used, but minimal evidence to support effectiveness
Older studies suggest that 15% resorcinol may be of benefit
1% topical clindamycin applied twice daily
Mild or moderate disease unresponsive to topical treatment
Tetracycline 500 mg twice daily or
Doxycycline/minocycline 50-100 mg twice daily
Moderate or severe disease
Rifampin 300 mg twice daily plus clindamycin 300 mg twice daily for 10 weeks (most well studied) may induce remission
Combined oral contraceptives, particularly those with third generation progestins such as gestodene, norgestimate or desogestrel
Combined oral contraceptive with drospirenone may be especially beneficial
Finasteride, a 5α-reductase inhibitor, is effective
Intralesional triamcinolone 3 mg to 5 mg
Can be used in mild cases without chronic lesions
Tumor necrosis factor-α blockers (such as adalimumab which is FDA approved), interleukin blockers and other immunosuppressive agents may be helpful for moderate to severe disease
Consider in patients who
Require long-term antibiotic treatments
Experience flares when antibiotic treatments were stopped
May be beyond scope of primary care providers
Consider referral for recalcitrant cases
Mild to moderate cases
Carbon dioxide laser evaporation of lesions or
Deroofing of chronic lesions and sinus tracts or
Skin-tissue sparing excision with electrosurgical peeling (STEEP)
Severe HS is treated with local or wide local excision with either primary closure, secondary intention, flap advancement or grafting
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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