Lindsay Wilson, MD discusses clinical pearls from her lecture Women's Health in Dermatology on Saturday, November 5, 2022 at the PA/NP Elevate-Derm Conference in Tucson, Arizona.
In this video
Dr. Wilson urges clinicians to remember that HS patients carry significant comorbidities — cardiovascular disease, diabetes, obesity, anxiety, depression and suicide, sexual dysfunction, and inflammatory bowel disease. Because dermatology providers are often the ones seeing these patients, she pushes to build comorbidity screening into the template so MAs ask the questions as a standard of care, and patients can be referred to the appropriate providers when needed.
On treatment, she favors using every medicine that offers some benefit in a condition without many great options. She reaches for metformin in overweight patients with central adiposity — checking a baseline hemoglobin A1C first — noting it's cheap, well-studied, and helps about 70% of patients reduce lesion counts. Finasteride works well for women with both hair loss and HS, and unlike spironolactone it can be used in men. She and a colleague are also curious whether spearmint tea, twice daily, might help HS patients the way Dr. Lio described for hormonal acne — "they'll be relaxed even if their HS isn't better."
- Screen HS patients for comorbidities — cardiovascular disease, diabetes, obesity, anxiety, depression, suicide, sexual dysfunction, and IBD — and build it into your template.
- Consider metformin for overweight HS patients with central adiposity; check a baseline hemoglobin A1C, and expect lesion-count reduction in about 70%.
- Finasteride treats hair loss and HS together, and is an option for men where spironolactone isn't.
- When spironolactone fails, spearmint tea twice daily is worth exploring as an adjunct, extrapolating from data in hormonal acne.
