Sample Consults

SPECIALTY
Dermatology

CHIEF COMPLAINT
Hidradenitis suppurativa

COMMENTS TO SPECIALIST
A 26-year-old male presents with an 8-year history of hidradenitis suppurativa (HS). He does not have a primary care provider or dermatologist. The patient has made multiple visits to the emergency department (ED) for incisions and drainage but has never been hospitalized. He does not take any routine medications. Cocaine/marijuana use, Ethyl alcohol (EtOH) abuse12pack+1/5daily prior to admission to this facility. He does not smoke cigarettes. Hereportshavingover25incisionsanddrainagesintheEDrelated to his HS.HS affects the bilateral axilla, groin, and lower back. He was started on Bactrim 3 days ago for an acute abscess to the right axilla. Exam: The patient demonstrated a full range of motion in all extremities with no distress. The patient’s vital signs were within normal limits, and he denies any complaint other than the HS.**DERM: There is a 1 cm nodule ”at 2 o’clock” with a small amount of purulent/sanguineous drainage upon manual expression with a 2 cm circumferential area of light erythema and warmth. There are varying degrees of induration/cyst-like features, mostly around the superior lesion, with multiple areas of ropelike scars and pitted skin in the R axilla. Flat lesion at 8 “o” clock with a peri-wound area that is soft, draining a scant amount of purulent fluid.

MAIN QUESTION
Currently on Bactrim for acute infection. He needs long-term treatment. Please recommend a plan of care. See attached photos.

For reference only. This eConsult is based on an actual request for specialist consultation. The primary care provider, specialist, and patient are de-identified to protect private health information (PHI).