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Hidradenitis Suppurativa

Clinical Cases

Case 1

  • 27-year-old female
  • No significant past medical history and she takes no medications
  • Denies GI symptoms
  • Presents for management of painful cysts on bilateral axilla with purulent drainage

Initial evaluation

  • Obese young female
  • Otherwise healthy
  • Indurated plaques with scattered nodules, cysts, and sinus tracts with moderate erythema in bilateral axillae
  • Diagnosis: hidradenitis suppurativa
  • No skin biopsy is required
  • Treatment options discussed; patient opts for systemic antibiotics. Rifampin 300 mg bid and clindamycin 300 mg b.i.d. is prescribed
  • Intralesional triamcinolone 5 mg/cc injection to active cysts
  • Follow-up in 1 month

Follow-up evaluation

  • The skin lesions are much improved and the patient reports that there is less significant (but still occasional) purulent drainage. Antibiotics are continued for 2 additional weeks
  • Follow-up in 1 month

One-month follow-up evaluation

  • Patient reports significant clinical improvement
  • Systemic antibiotics are discontinued and the patient is switched to topical benzoyl peroxide and clindamycin
  • She continues to return for follow-up every 3-4 months, requiring occasional intralesional triamcinolone 5 mg/cc injection to active cysts and sinus tracts

Case 2

  • 21-year-old male
  • No significant past medical history and she takes no medications
  • Denies GI symptoms
  • Presents for management of painful cysts and plaques with purulent drainage on bilateral axilla, groin, buttocks/perianal area, infra-abdominal pannus

Initial evaluation

  • Obese young male
  • Otherwise healthy
  • Indurated plaques with scattered nodules, cysts, and sinus tracts with moderate erythema in bilateral axillae, inguinal folds, buttocks, perianal area, infra-abdominal pannus
  • Diagnosis: hidradenitis suppurativa
  • No skin biopsy is required
  • Treatment options discussed; patient opts for systemic infliximab. The plan is to start infliximab at 5 mg/kg dose on weeks 0, 2, 6, 10, 16, and every 6 weeks thereafter
  • Pre-treatment labs: complete blood count (CBC) with differential, liver and kidney function tests, hepatitis viral serologies, PPD. A test dose of methotrexate 2.5 mg once a week is given with normal follow-up CBC. The dose is escalated to 5 mg per week
  • Intralesional triamcinolone 5 mg/cc injection to active cysts
  • Referral to dermatologist for ongoing management of infliximab (the patient has complete resolution of symptoms within 3 months).