Diagnostic steps

The specialists explain the roadmap to reach the clinical diagnosis of the disease and the most appropriate treatment for each patient.

Dr.. Gabriel Arias, resident of the Department of Dermatology at the Medical Sciences campus, and Dr. Adriana Figueroa, resident of the Department of Dermatology at the Medical Sciences campus. Photo: Submitted by Physicians to the Journal of Medicine and Public Health.

during a seminar hidradenitis Led by the Journal of Medicine and Public Health, the Dr. Adriana FigueroaDr. Gabriel Arias, a fellow in the Department of Dermatology at the Medical Sciences Campus, explained the steps that must be followed to reach a diagnosis of the condition, and at the same time his colleague Dr. Gabriel Arias detailed the necessary treatments for patients, allowing highlighting the importance of managing this condition, which is three times more common in women than it in men.

according to Dr. Adriana FigueroaHidradenitis is a systemic, chronic and inflammatory skin condition, which is also known as acne versa. “By systemic, we mean that it affects all parts of the body and is chronically long-term,” he said.

Although no specific cause is known, specialists show that it originates in the hair follicles, the structure of the skin where hair grows, where it becomes clogged, begins to accumulate sweat, and encourages the growth of bacteria, which leads to the occurrence of infections and the appearance of pimples.

“Without the right treatment, what happens is it keeps spreading and the condition progresses; it can even create large scarring or tunnels under the skin,” Figueroa said, also stressing that the disease can spread to distant areas where it started.

spread and fall

The condition can affect anyone, usually begins in the teenage years, is most at risk in patients with a family history, and is more common in African Americans, white people, and Hispanics. Also, according to a specialist, hidradenitis has been associated with cigarette use, “It is estimated that 3 out of 4 people with HS are smokers and 15% are smokers at some point.”

Likewise, it is associated with overweight and obesity, with 75% of patients having the condition. “The higher a person’s weight, the greater the risk of disease and the greater the risk of developing a serious illness,” he added.

How do you reach the diagnosis?

According to Figueroa, the diagnosis is clinical, as they can’t tell if a patient has hidradenitis or not from blood samples, “It’s kind of tricky, which is why many patients go 7 to 10 years without receiving a diagnosis.” Unfortunately they come in a rather advanced state.”

Despite this, he explained the steps that can help with the diagnosis. The first thing doctors should consider when dealing with a patient with related symptoms is to answer four questions:

Is there more than one swollen lesion?

Is the course chronic with new and recurring lesions?

Are the lesions bilateral?

Are the lesions mainly present in the milk line?

If all the answers are yes, then this means that the patient has hidradenitis suppurativa, if not for one or more questions, he can perform a culture of bacteria, fungi and other microbes. If clear, culture containing one species is an infection, if culture is sterile or contains more than one species, patient history and gastrointestinal symptoms should be reviewed; Then, if there are no related conditions, it may be hidradenitis suppurativa.

The specialist assures that dermatologists classify the disease by Hurley stage, from mild to severe. In stage 1 (mild), there are inflamed lesions, however, there is no scarring, there is no subcutaneous tunnel, and there is a space between one lesion and another.

“In the second (intermediate) stage, we notice recurring nodules and abscesses, and there is scarring and there may be fistula formation, but it is important to realize that the area is not completely affected, although it causes pain to the patient,” he said. .

And in the third stage, there is an almost diffuse involvement of the area, the cysts cover the entire area, which leads to a condition in the anatomical structure of that part of the body.

Confronting this, Dr. also explained that hidradenitis is not a sexually transmitted disease, it is not contagious, it is not caused by poor hygiene of patients and they are not responsible for the development of the condition.

On the other hand, Dr. Gabriel Arias, Fellow in the Department of Dermatology at the Medical Sciences Campus, stresses the importance of being aware of any change or symptom experienced by patients, as this will be determined by the severity of the condition being treated.

“Sometimes they are treated as if they were infections, and the diagnosis of HS is reached by a dermatologist; although there is no cure if there are treatments that help reduce outbreaks and pain and prevent the condition from getting worse,” he added.

What are the treatments?

One of the recommendations that the specialist gives to his patients is the use of antiseptic soap, as it helps reduce the bacterial load and inflammation. There are also short courses of oral steroids, such as prednisone, which states that “they can be used in short periods for the acute phase, but not for the prolonged phase.” In addition, zinc supplements stand out, as they contribute to reducing the inflammatory environment characteristic of the condition.

Just as hidradenitis suppurativa is categorized by stages, so is the treatment. Arias points out that “in the first stage, systemic treatments are used until they reach the depth of this type of lesions,” some of which are: oral antibiotics (tetracycline, clindamycin + rifampin), hormonal therapy (spironolactone, metformin, finasteride) and retinoids (isotretinoin). ).

For phase II, additional antibiotics (moxifloxacin, metronidazole), prebiotics (adalimumab, infliximab), ablation, and laser may be included. and in phase 3 intravenous antibiotics (ertapenem), biologics (anakinra, ustekinumab) and circumcision.

In this regard, the specialist says that “this is an inflammatory disease, so our goal is to be able to control it early to prevent the patient from undergoing surgical procedures”, and considers that surgical management acts as a treatment adjuvant to the treatment physician, that is, when the patient does not respond to it or when there is Evidence of extensive structural damage, but “surgery should not replace treatment nor treat inflammation”.

Recommendations for patients

Finally, specialists recommend multidisciplinary treatment to manage the condition in patients. Dr. confirms. hidradenitis You should go for an evaluation and make a definitive diagnosis. In medical school clinics we can catch them.”

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