Hidradenitis Suppurativa Recurrence in a Caesarean Scar
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A 33-year-old female known for the management of HS, successfully managed with Humira (adalimumab) 40 mg injections weekly. She became pregnant with her first child and continued Humira until the end of the second trimester. She gave birth via emergency cesarean at 39 weeks to a healthy 3.59 kg male following induction of labor, failure to progress, and fetal bradycardias. Her HS remained silent throughout the pregnancy and after the birth, until approximately one week later when three painful nodules appeared in her left axilla. She self-recommenced Humira at this time, after ceasing breastfeeding, and these nodules settled. Approximately two months later, she noted the appearance of small nodules and inflammatory tracts around her cesarean scar.

These were initially thought to represent a fungal infection and were treated with an over-the-counter antifungal cream with limited efficacy. She was subsequently treated with topical antimicrobial preparation containing gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide, followed by oral amoxicillin and clavulanic acid, and potassium permanganate soak to the area, all of which provided minimal improvement. Patient-reported excellent compliance with all wound care instructions at the time of delivery and noted significant distress at being told that her symptoms were the result of insufficient wound care and recurrent infection of the area.

Her HS lesions involving her cesarean site responded well to treatment with doxycycline 100 mg daily and Prontosan Wound Gel and Wash (polyaminopropyl biguanide (polihexanide), betaine surfactant) in addition to Humira, with discharging sinus tracts persisting until review six months after the onset of symptoms, and complete resolution by review at one year.

Source: https://www.hindawi.com/journals/criog/2020/6283720/
Dr. j●●●i b●●●●●n and 1 others like this
Dr. J●i B●●●●i
Dr. J●i B●●●●i Obstetrics and Gynaecology
Excellent management of the case.
Mar 12, 2021Like