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Imaging Techniques in Hidradenitis Suppurativa and Comorbidities

Introduction The imaging support of hidradenitis suppurativa (HS) has been increasing in the last decade due to the development of high-axial-resolution devices that can detect simultaneously and with high definition abnormalities of the skin and deeper layers. Nowadays, the spatial axial resolution, which allows the discrimination of two adjacent reflector points, is much higher on ultrasound than MRI or CT. It should be kept in mind…

Histopathology of the Pilosebaceous Unit and Interstitium of Hidradenitis Suppurativa

Introduction It is useful to consider the histological findings of hidradenitis suppurativa (HS) lesions in the context of populations at risk for HS to understand the clinical differences observed amongst these populations. HS disproportionately affects women, persons 18 to 29 years of age, and African Americans (AA). Women are more likely to have axillary and upper anterior torso involvement, while male HS patients are more likely…

Hidradenitis Suppurativa Differential Diagnosis and Mimickers

Introduction The average length of time from onset to diagnosis in hidradenitis suppurativa (HS) patients worldwide is 7.2 years. This unfortunate delay is partly because of the nonspecific nature of many HS lesions—inflammatory papules, nodules, pustules, abscesses, and scarring—which may be confused with a variety of other cutaneous diseases. The diagnosis may also be confounded by coexistence or overlap with other inflammatory diseases presenting with similar…

Clinical Manifestation and Phenotypes of Hidradenitis Suppurativa

Clinical Manifestation Morphology of Hidradenitis Suppurativa Lesions A key component of the diagnosis of an individual with hidradenitis suppurativa (HS) involves examining for the presence of typical HS morphology. The quantity and location of lesions indicate the severity of HS. It is important to consider the possibility of multiple lesion types coexisting simultaneously, together contributing to the severity of HS. Certain lesions (e.g., open comedones, small…

Hidradenitis Suppurativa Epidemiology

Introduction This chapter will focus on the epidemiology of hidradenitis suppurativa (HS), examining the body of evidence available for estimating the incidence and prevalence of HS, and the distribution of HS by gender, age, and race. Epidemiology is a broad subject that also encompasses the risk factors for disease development and the impact of a disease on societal metrics, such as the likelihood of people with…

Historical Perspective on Hidradenitis Suppurativa

Introduction Hidradenitis suppurativa (HS) has a convoluted history with conflicting bodies of knowledge and a complicated pathogenesis. Since HS was first described in the 19th century, it has taken on various names and treatment strategies, leading to further confusion among researchers, physicians, and affected individuals. Alfred Velpeau and Aristide Verneuil are prominent historical figures who are credited with the discovery and characterization of HS centuries ago.…

Core Questions for Understanding Systemic Dermatologic Drugs

Section 1— Pharmacology basic science Section 2— Clinical use Section 3— Severe adverse effects Section 4— Less serious adverse effects Section 5— Drug safety monitoring Section 6— Drug interactions ( see also Appendix 2) Section 7— Miscellaneous issues Section 1—Pharmacology Basic Science Q1.1 What are the simplest definitions of ‘pharmacokinetics’, ‘pharmacodynamics’, and ‘pharmacogenetics’? ( Pg. 1, Table 1.1 ) Q1.3 What are some of the pros…

Dermatologic Drug Therapy in Children

Questions Q70.1 How does the relatively high body surface area-to-body volume ratio in infants relate to a relatively high risk of complications from topical medications? (Pg. 768) Q70.2 What are (1) some of the important barriers to compliance in children, and (2) some of the best measures to attain greater compliance? (Pg. 768) Q70.3 Why is the risk of topical corticosteroids applied to the diaper area…

Compounding in Dermatology

Questions Q69.1 What are several of the driving forces for the recent increase in compounding in all of medicine? (Pg. 759) Q69.2 How are compounded preparations regulated compared with manufactured products? (Pg. 760) Q69.3 What is meant by the ‘compounding triad’ and who are the key triad components? (Pg. 760) Q69.4 What factors should be considered in deciding whether to use a compounded preparation for treatment?…

Informed Consent and Risk Management

Questions Q68.1 What are some of the important medical benefits (for the patient) from a truly informed consent process? (Pg. 754) Q68.2 What are important differences between ‘express’ consent and ‘implied’ consent? (Pg. 754) Q68.3 What are some malpractice and regulatory issues involved in prescribing medications for unapproved (‘off-label’) purposes? (Pg. 754) Q68.4 In the broadest sense, what are the elements that the informed consent process…

Cutaneous Drug Reactions With Systemic Features

Questions Q67.1 Which drugs or drug groups most commonly induce the drug reaction with eosinophilia and systemic symptoms (DRESS)? (Pg. 743) Q67.2 Which anticonvulsants have the potential to cause DRESS; to which category do all but one of these anticonvulsants belong? (Pgs. 745, 746) Q67.3 What are the metabolites of sulfonamide antimicrobials and dapsone that may have a causal role in the DRESS? (Pg. 746×2) Q67.4…

Drug Interactions

Questions Q66.1 What are several drugs with a narrow therapeutic index, which increases the likelihood of relatively serious drug interactions? (Pg. 726) Q66.2 Which drugs are highly protein bound, increasing the likelihood of significant increases in free drug concentrations, when displaced from these binding proteins? (Pg. 728) Q66.3 Which sites in the body have the greatest P-glycoprotein concentrations, and what is the teleologic reasoning of ‘placement’…

Dermatologic Drugs During Pregnancy and Lactation

Questions Q65.1 How did the 2015 Pregnancy and Lactation Labeling Rule change the US Food and Drug Administration (FDA) format of drug labeling? ( Pg. 711 ) Q65.2 What are five general concerns all physicians should consider when prescribing drugs to women of childbearing potential? (Pg. 711) Q65.3 Which medications have been well documented to cause failure of (a) intrauterine devices, and (b) oral contraceptives? (Pg.…

Drug-Induced Malignancy

Questions Q64.1 How can clinicians establish drug causation for all drug adverse effects, including the possibility of drug-induced malignancy? (Pg. 701) Q64.2 What are the pros and cons of using the s urveillance e pidemiology and e nd r esults (SEER) database in the United States as a ‘control group’ (or comparable databases for other countries) compared with disease-specific databases in determining the risk of drug-induced…

Hematologic Toxicity of Drug Therapy

Questions Q63.1 What are two enzymes for which baseline testing serves to predict patients at risk for hematologic toxicity from drugs commonly used in dermatology? (Pgs. 690, 694, 695) Q63.2 What are some of the mechanisms by which hydroxylamine metabolites induce hematologic toxicity in patients on either dapsone or sulfonamides? (Pgs. 690×2, 695) Q63.3 What are several drugs that induce antibodies specific to platelets or neutrophils?…

Hepatotoxicity of Dermatologic Drug Therapy

Questions Q62.1 Concerning various categories of liver disease, what percentage of patients likely have drug causation: (1) adults with hepatitis, (2) adults with hepatitis at least 50-years-old, (3) all patients with fulminant hepatitis? (Pg. 678, Table 62.1 ) Q62.2 What are several of the drugs removed from the United States market because of severe liver toxicity? (Pg. 678) Q62.3 What is the purpose of the metabolic…

Oral Mucosal Therapeutics

Questions Q61.1 Given the various conditions associated with erosive gingivitis, which conditions are best treated with (1) topical corticosteroids alone, (2) topical calcineurin inhibitors, (3) systemic corticosteroids or (4) other immunosuppressive therapies? (Pg. 666) Q61.2 What are some factors which influence the choice of topical medication vehicle when treating oral diseases? (Pg. 666×2) Q61.3 What are several of the principles clinicians can use to maximize the…

Botulinum Toxin Injections

Questions Q60.1 What are the major serotypes of botulinum, and what are the characteristics of botulinum neurotoxin A that make it most suitable for dermatologic use? (Pg. 657) Q60.2 What is the general mechanism by which botulinum toxin relaxes facial rhytides (wrinkles) and reduces sweating? (Pg. 657) Q60.3 Specifically, which serotypes of botulinum toxin inhibit SNAP-25 and which serotypes inhibit synaptobrevin (VAMP)? (Pg. 657) Q60.4 What…

Injectable Dermal and Subcutaneous Fillers

Questions Q59.1 Which fillers require allergy testing before injection? (Pgs. 651, 653) Q59.2 How does the ‘moldability’ of hyaluronic acid compare with that of calcium hydroxyapatite? (Pg. 651×2) Q59.3 Which fillers can be dissolved if there are undesirable effects? What product is used to dissolve the filler? (Pg. 651) Q59.4 Which fillers currently on the market are manufactured with lidocaine? (Pgs. 651, 653 Table 59.1 )…