Management of newly-diagnosed Hidradenitis Supparativa in the skilled nursing facility setting during the COVID pandemic: a case study.

Introduction: Hidradenitis supparativa (HS) is a chronic inflammatory skin condition that primarily involves intertriginous skin areas of the axillary, groin, perineal, perianal and inframammary regions. The clinical manifestations vary from recurrent abscesses and inflamed nodules to draining sinus tracts and severe scarring, which makes early diagnosis and treatment very important to prevent disabling, end stage disease.

This case study describes the management of a new diagnosis of HS involving the groin/thigh in a 59 year-old black male in a skilled nursing facility during the COVID pandemic when in-person visits to outpatient clinics were being minimized.

Methods: Initially, calcium alginate and a non adherent dressing were applied daily over draining sinus tracts and nodules. Punch debridement was performed occasionally when indicated. Topical clindamycin (1% solution twice daily) and oral doxycycline (100mg twice daily) were added to his regimen after initial progress stalled.

Results: Large area involving the right medial thigh (Hurley Stage III) measuring 83.62 sq cm on presentation improved to 24.32 sq cm after 3 months and completely resolved at 6 months of treatment. Left groin wound (Hurley Stage II) improved from 24.5 sq cm at presentation to 6.9 sq cm and 0.35 sq cm, at 3 months and 6 months, respectively. No adverse events were noted during this time.

Conclusion: This case study illustrates the importance of early identification and treatment of HS especially when referral to specialty care is not readily available during the COVID pandemic. The timely intervention is key to minimizing progression to debilitating, end stage disease. Larger studies are needed to asses the impact of prompt diagnosis and intervention in settings such as this on the outcomes of patients with HS.