Management

■ If identified within 72 hr, oral antiviral therapy can speed healing and decrease pain (PHN): Acyclovir 800 mg 5 x d x 7 d, famciclovir 500 mg tid x 7 d, or valacyclovir 1000 mg tid x 7 d.

■ If tip of nose involved/V1 dermatome facial involvement: Urgent ophthalmology consult—Ocular involvement can lead to blindness.

■ PHN: Difficult to manage, best prevented by immediate antiviral therapy; analgesics, topical lidocaine, capsaicin, narcotics, nerve blocks, gabapentin, tricyclic antidepressants may be helpful; pain clinic referral. Prednisone occasionally used in elderly in addition to antivirals for herpes zoster (controversial).

Hidradenitis Suppurativa

Hidradenitis Suppurativa Pictures Groin

Etiology: Chronic recurrent inflammatory condition wherein hair follicles are occluded and become secondarily infected. Associated with obesity, diabetes, and smoking; genetic and hormonal components.

History: Pain, odor, and drainage affecting axillae and/or groin.

Physical: Comedones, pustules, and nodules, abscesses, sinuses, and scarring. Severe form associated with acne conglobata, pilonidal sinus, & dissecting cellulitis of scalp.

Investigations: Clinical diagnosis; can swab for bacterial cultures.

DDx: Folliculitis, infected cysts, inflammatory bowel disease.

Management

■ Distressing condition with no satisfactory treatment.

■ Topical and systemic antibiotics (e.g., clindamycin and tetracycline), intralesional corticosteroids, hormonal therapy, retinoids (e.g., isotretinoin, acitretin).

■ Daily cleansing with antibacterial soaps.

■ Female patients benefit from antiandrogen therapy such as cyproterone acetate or spironolactone.

■ Surgery is required for more recalcitrant cases and can be curative.

■ Encourage patients to quit smoking and lose weight.

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