This is typically done in consultation with a dermatologist.
#HIDRADENITIS SUPPURATIVA 3RD MOST PAINFUL DISEASE SKIN#
A wound vac is applied over the skin graft for 5 days.įor stage 3 HS, you can also consider medical therapy with clindamycin 300 mg BID with rifampin 300 mg BID and a TNF α inhibitor such as adalimumab or infliximab 1.
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This is an extensive process requiring resection of HS and wound vac placement, wound vac changes, and skin grafting 1 week later, if the tissue is granulating well. Local surgical treatments such as unroofing tracts, wide local excision of lesions, skin tissue–sparing excision with electrosurgical peeling (STEEP) surgery and carbon dioxide laser evaporation of diseased tissue may be used forstage 2 HS.įor stage 3 or severe HS, radical wide excision with skin grafting is recommended for definitive treatment (Figure 3). 1 For stage 2 disease, other oral agents can be considered (sulfamethoxazole-trimethoprim, dapsone, or a combination of rifampin, moxifloxacin, and metronidazole), with maintenance on doxycycline or minocycline for approximately 3 months. Anti-androgens such as drospirenone-containing oral contraceptives, spironolactone (50-100 mg po daily), or finasteride (5 mg po daily) may be helpful to control disease. Intralesional triamcinolone injections are used at times. Other therapies offered include topical clindamycin lotion 1% twice daily. 11 This is available in a single pill to be taken twice a day. Patients are also advised to take zinc picolinate (30 mg) with copper gluconate (2 mg). Other antibiotics that can be considered include doxycycline (100 mg po twice daily) or clindamycin (300 mg po twice daily) for 7 to 10 days. 1,3įor the initial flare, amoxicillin/clavulanic acid (875 mg po every 12 hours for 7 to 10 days) helps to treat the inflammation and secondary infection. 1,3 Behavioral and dietary changes such as weight loss, smoking cessation, and elimination of dairy products are encouraged as well. For stage 1 disease, patients are treated with general care measures, including avoiding vulvar irritants and tight clothing. Most therapies target suspected underlying mechanisms. The therapeutic goals of treatment are to treat active disease and prevent disease progression. 1 Finally the most severe stage is stage 3, consisting of diffuse disease with multiple connected tracts, tunnels, and significant scarring.
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1 If multiple lesions are present, they are separated by normal skin. 1 Stage 2 is characterized by recurrent abscesses (single or multiple) with sinus tracts or scarring. 1 Stage 1 is characterized by transient abscess formation without scarring and sinus tracts. 1,8,9 Mean time to diagnosis is 7.2 years, which is unfortunate as the disease can be progressive and debilitating. HS is seen primarily after puberty and before menopause, with women affected more commonly than men. 1,3 Androgens also play a role likely secondary to an increased end-organ sensitivity of androgen receptors mediated by insulin and insulin-like growth factor. 6 Infection appears to be a secondary reaction.
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1,3-5 HS also is thought to have a genetic component, with multiple genes likely to be involved. As the body attempts to heal, chronic inflammation occurs, creating chronic tissue damage and resultant scarring. 3,4 In turn, an acute inflammatory response develops in the surrounding tissue. 3,4 This results in weak-walled follicles that when occluded ultimately rupture, resulting in release of multiple inflammatory factors. It has been suggested that HS develops due to a defect in the folliculopilosebaceous unit.
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HS is a chronic inflammatory skin condition that involves skin in areas where apocrine glands are found. The most likely diagnosis in this patient is hidradenitis suppurativa (HS) (Hurley stage 2) and you could use all of the listed treatments to address this condition.