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Hidradrenitis Suppurative - Coggle Diagram
Hidradrenitis Suppurative
Come up once in exams
definition
Chronic inflammatory disorder
Usually begins in puberty
Affects intertiginous areas
Characterised by
Double commedones
pathomneumonic
Pustules
Nodule and abscess formation
Tunnel (sinus tract / fistula) formation - drainging and non draining
Hypertrophic scar formation - bridging scars
Epidemiology
1-4% population
F>M 3:1
Big impact on QoL
Associated with co-morbidities
Perianal more common in men
QoL
Pain - extreme
Discharge tunnels - odour /clothing
HiSQOL
Co-morbidities
Metabolic syndrome / T2DM
Psychiatric disorders - depression, anxiety
Cardiovascular
Acne
PCOS
Hurley Stage
1
Single / multiple abcess
No scaring
2
Recurrent abcessess
Sinus tract formation
Some scarring
3
Widespread
Significatn scaring
Tracts connect
Path
Immune driven
Smoking is risk factor
Obesity RF
FHx / genetics - 1/3 pt
Startsin puberty, lessa ctive in 50s in females and then remission in menopaiuse
Not infective
Not associated with hygiene
Mx
Mild
Topical antibiotics (anti-inflammatory properities)
Topical clindamycin
Topical steroid for inflam
Moderate~
Oral abx
Tertracyclines
Rifampicicna and clinca
...
Adjuncts
Intralesional topical steroids
Metformin
Lifestyle
NB stop smoking
Weight loss consider GLP1 - not reimbursed
Pain mx
PAra - Ibprofen - opioids
Wound care - absorbant dressings - Hidrawear
Severe Disease
3 FDA biologics
Adalidumab
Sekukinumab
Bimekizumab
Improve but does not clear
Many do not improve
Surgery
Not in IRE
Deroofing of sinus tract
Wide local excision
Radical excision surgery
