Ep 12. Hidradenitis Suppurativa Bootcamp: Risk Factors, Clinical Features, and Management

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Hidradenitis Suppurativa (HS) Boot Camp: Diagnosis, Hurley Staging, Treatment Ladder & Surgical Options | The Derm Resident

Contact: thedermresident.pod@gmail.com

Dr. Jonny Hatch and Dr. Deven Curtis deliver a clinic-focused boot camp on hidradenitis suppurativa (HS), noting the misnomer (not a sweat-gland disease) and reviewing typical intertriginous involvement with painful nodules/abscesses and the pathognomonic double-ended open comedone. They discuss delayed diagnosis, stigma, family history, modifiable factors (smoking and obesity), and flare triggers (menses, friction, sweating, heat, diet). Hurley staging is outlined (I boils only; II recurrent abscesses with sinus tracts/scars; III diffuse interconnected tracts) with emphasis that severity and inflammation may not perfectly match stage. They highlight disease burden (pain, depression screening; associations with Crohn disease, PCOS, metabolic syndrome), exam pearls, and a treatment ladder: topicals (clindamycin with BPO), oral antibiotics (doxycycline, clinda/rifampin; rescue options), hormonal therapy, biologics (adalimumab, infliximab, IL-17 agents), and procedures (I&D, punch deroofing, deroofing, wide excision, reconstruction), plus counseling that HS is chronic, not due to hygiene, and requires ongoing support.

00:00 HS Boot Camp Intro
00:30 Name Origins and Misnomer
02:06 Classic Presentation and Diagnosis
05:04 Risk Factors and Flare Triggers
07:09 Hurley Staging Basics
11:12 Disease Burden and Comorbidities
13:13 Topicals and Lifestyle First Line
15:20 Oral Antibiotics and Escalation
16:58 Hormonal Therapy Pearls
20:00 Biologics for Moderate Severe HS
24:20 Surgical Options and Deroofing
29:38 Patient Counseling and Wrap Up

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