• Skip to primary navigation
  • Skip to main content
  • Skip to primary navigation
  • Skip to main content
Choose which site to search.
University of Arkansas for Medical Sciences Logo University of Arkansas for Medical Sciences
College of Medicine: Department of Family and Preventive Medicine
  • UAMS Health
  • Jobs
  • Giving
  • About Us
    • The DFPM Chair
    • Department News
    • Verification of Residency Training
    • Available Positions
  • Residency Programs
  • Community Health and Education
    • Upcoming Events
    • CME/CE for Family Medicine
    • Partnerships in Colorectal Cancer Screening for Arkansas
      • Who We Are
      • Providers’ Resources for Colorectal Cancer Screening
      • Patient Resources
      • PiCS-AR! Raises the Bar
  • Research and Scholarly Activity
    • Clinical Research
    • Community Research
      • Research & Evaluation
        • Arkansas Early Childhood Care & Education Financing: Cost Modeling & Market Price Analysis
        • Arkansas Workforce Studies
        • Child & Youth Mental Health
        • Healthy Families America (HFA)
        • Home-Visiting Support for Low-Birth-Weight Preterm Infants
        • Parents as Teachers (PAT) Arkansas
      • Research-Based Early Childhood Professional Development
        • Engage Continuum
        • FIRST:ECE
        • TIPS
        • WOW
        • Family Map
        • Project PLAY
        • REACH
        • WISE
        • Strengthening Families
      • Research and Evaluation Division Faculty
        • Nikki Edge, Ph.D.
        • Lorraine McKelvey, Ph.D.
        • Taren M. Swindle, Ph.D.
        • Kanna Lewis, Ph.D.
      • Contact RED
    • Publications
  • Medical Student Education
    • Junior Clerkship
      • Clerkship FAQs
      • Clerkship Syllabus
      • Contacts
      • Community and Housing
    • Senior Students
      • Residency Resources and Timeline
      • Post Match Survey
      • Student Alumni Sign-up Form
    • Scholarships and Loan Repayment
      • Harold H. Hedges III, M.D., Endowed Scholarship in Family Medicine
    • Student Conferences
  • DFPM Offices
    • Communication and Departmental Relations
    • Digital Health
    • Leadership and Professional Development
      • DFPM Chair’s Awards for Recognition of Excellence (CARE)
        • Chair’s Awards for Recognition of Excellence Nomination Form
    • Wellness
  1. University of Arkansas for Medical Sciences
  2. College of Medicine
  3. Department of Family and Preventive Medicine
  4. Department News
  5. Page 2

Department News

Hidradenitis Suppurativa: Three Questions to Diagnose and Five Layers of Treatment

Hidradenitis suppurativa (HS) is a skin disorder that starts with blocked hair follicles, leading to painful nodules, abscesses and scarring. Front-line providers can work with dermatologists to diagnose and treat this often debilitating condition by asking three questions and following a five-tiered approach to treatment.

Dr. Vivian Shi, former UAMS dermatologist and director of the hidradenitis suppurativa clinic, offered tips to family medicine providers at the UAMS 2024 Family Medicine Spring Review last April. She said, “It requires a multidisciplinary approach. An HS team including all of these specialists and dermatology providers are the principal providers, but we really lean on front-line providers … to detect, treat, refer and to collaboratively manage.”

Picture of Vivian Shi, MD
Vivian Shi, M.D.

Most of her HS patients have had it more than 10 years after having seen their providers at least five times, and around 15% are disabled or unable to work because of HS pain. Girls typically show signs in their early teens, and boys start in their mid to late teens. If the teen has severe acne, have the patient lift the arms to check for HS signs. The typical onset is between puberty and age 40, with women being three times more likely to be affected.

Three key diagnostic questions every provider must ask the patient:

1. In the last 12 months, did you repeatedly have big, painful nodules and boils in the armpits or groin?

2. Have you had outbreaks of boils in the last six months?

3. Do you repeatedly have outbreaks of big sores, painful nodules or boils that heal with scars in any of these locations?

If the answer is “yes,” there is a 90 percent chance of HS.

“There’s no reason healthcare providers should be missing this if they ask these questions,” said Dr. Shi.

HS can show up anywhere on the body – behind the ears, outer arms or legs – not just the skin folds and areas with sweat glands. The two exceptions are the palms and soles of the feet. It’s chronic, inflammatory and very painful. Initially, the patient will have inflamed nodules, abscesses, white heads and black heads. The more advanced stage includes draining sinus tracts (narrow channels) and severe scarring, which are especially true in Blacks. Often it is misdiagnosed as cellulitis.

pictures of 3 Hurley stages

HS is divided into three Hurley Stages. The mildest is Hurley Stage 1: Abscesses that resolve without any trace of scarring, but this is rare.  As soon as the patient has any sign of a scar, it’s labeled Hurley Stage 2. This stage includes recurrent abscesses, sinus tracts and scarring, but normal-looking skin will appear between them. The most advanced stage is Hurley 3, characterized by multiple connected sinus tracts and abscesses across the entire area with little to no normal-looking skin between. She describes it as an “over-exaggerated inflammatory response where, over time, the hair follicles connect with each other and form sinus tracts and extensive scarring.”

Dr. Shi recommended a pyramid of treatment. The front-line provider can manage all the treatments except for biologics, the top tier. In early moderate to severe patients (late Hurley 1 to early Hurley 2), Dr. Shi suggested preparing patients for biologic therapy by prescribing oral antibiotics because payors typically require patients to fail 90-plus days of systemic antibiotics to qualify. Regardless of disease stage, providers should refer the patient to a dermatologist for advanced therapy, while collaboratively managing the patient.  

The 5 Tiers of Treatment:
Top layer - Biologics
Second layer - Hormonal Treatments
Third layer - Oral Antibiotics
Fourth layer - Topicals
Bottom Layer - Lifestyle Modification

Lifestyle Modification

The first tier of the pyramid is lifestyle modifications where the provider would screen for comorbidities and start treatments. In a recent JAMA Dermatology report, patients with HS said diet changes were the most used non-prescription treatment with the Mediterranean diet and intermittent fasting both being effective. The two exercises that HS patients can tolerate are Pilates and swimming. Weight loss surgery is also a strong consideration if the patient is greater than 35 BMI, and if the patient smokes, encourage them to quit since cigarette smoke has dioxin-like compounds that can cause acne and scarring. Loose-fitting clothing and anti-chaffing products applied in skin folds can reduce friction and pain.

If the patient has draining sinus tracts, bathing helps to rinse out the tunnels. Dr. Shi recommends alternating daily with 10-minute baths of Epsom salt, CBD oil and ¼ cup 6% commercial bleach which help with pain, itch, relaxation and decrease biofilm.

Topicals

The next level is topical treatments. She typically uses clindamycin 1%; however, resorcinol 15% elicits a better response in mild to moderate HS. Resorcinol is especially helpful because it breaks down the outer layers of the skin and unplugs the hair follicles. There are also washes such as benzoyl peroxide, chlorhexidine or dapsone. Dr. Shi cautioned against benzoyl peroxide wash used together with topical dapsone because they’ll have reversible yellowing of the hair follicles.

Oral Antibiotics

Dr. Shi’s office typically starts with the tetracycline family because it’s better at reducing inflammation in the hair follicle and less costly. She recommends 100 milligrams of doxycycline or minocycline twice daily or extended release minocycline at a weight-adjusted dose once a day for eight to 12 weeks. Dr. Shi cautioned that dosage may need to exceed 100 milligrams for it to work, so ensure the patient doesn’t have anemia. She uses this for flare-ups or to bridge to biologic therapy.

Rotating through combined systemic antibiotics also works, being careful not to extend beyond three months. One combination is clindamycin with rifampin. A second choice is rifampin with moxifloxacin and metronidazole, which is especially helpful for drainage. And one thing providers want to consider is to stop the metronidazole after six weeks because longer use can cause reversible peripheral neuropathy.

Certain supplements also should be considered. Persons with HS typically have lower serum zinc levels. Prescribing 100 – 200 milligrams of daily zinc (with copper included after two months) has shown to reduce HS severity in 80% of patients. Another supplement to consider is Vitamin D since most patients with HS are deficient. Vitamin D regulates hair cycle and skin cell activity.  

Hormonal Treatments

Dr. Shi recommends these hormonal / metabolic therapies:

Hormonal and Metabolic Therapies
For Women - Spironolactone 50 - 150 mg daily. Monophasic OCP (with increased estrogen and with anti-androgenic progestin such as drospirenone)
For Men -- Finasteride 5-10 mg daily
For Both - Metformin 500 mg - 1500 mg daily (for patients who are obese or have diabetes). Also Metformin XR.

Biologics
Biologics is the last step of treatment. Dr. Shi said providers should learn the basics of biologics so they can explain how it works before they refer to a dermatologist.  The patient must be on at least 90 days of an oral antibiotic before most insurance will allow biologics.

Dr. Shi’s takeaways:

  • Ask the three questions to have a high confidence of diagnosing HS.
  • Refer to dermatology once diagnosed.
  • Screen for metabolic syndromes, inflammatory bowel disease, hormonal and mental health abnormalities.
  • Reverse screen for HS if the patient has Down syndrome.
  • Start antibiotics if the patient has any scarring because biologics is the next step. Most insurance requires 90 days to four months of oral antibiotic to be eligible for biologic treatment, so this is the referral window.
  • More information on HS can be found at hs-foundation.org

    If you’re interested in more of UAMS’ primary care CME/CE, check out our list of upcoming CME/CE here.

Filed Under: Community Health and Education Tagged With: diagnosis and treatment of hidradenitis suppurativa, family medicine approach to hidradenitis suppurativa, hidradenitis suppurativa

Diane Jarrett Ed.D., M.A., is Published in JAMA Ophthalmology

Diane Jarrett Ed.D., M.A. has had a letter to the editor published online ahead of print in JAMA Ophthalmology.

Dr. Jarrett writes in response to a previous article about the need for vision screening for children from socioeconomically vulnerable groups, giving her personal take on being a child who benefited from free school-based vision screening.

View the online article. The print edition will be available in July.

Vision screening

Filed Under: Department-Wide News, Residency

STFM Spring Conference in Los Angeles Showcases DFPM Scholarly Activity

The DFPM was well-represented at the Society of Teachers of Family Medicine’s annual spring conference, which this year was held in Los Angeles. DFPM offerings included:

A Completed Project by Dr. Leslie Stone, Dr. William Ventres, and Dr. Julia Roulier titled “Philosophy of Family Medicine (An Update) –Teaching the Principles and Role of Family Medicine During the Junior Clerkship.” (They are pictured above, along with Dr. Wayne Bryant Jr. on the left and Dr. Stephen Foster on the right.)

A Scholarly Topic Roundtable by Dr. Lauren Gibson-Oliver titled “A Comprehensive Document and Improvement Process for Supporting Residents Through Academic and Professionalism Issues.”

Dr. Shashank Kraleti and Diane Jarrett EdD co-authored a poster titled “Executive Leadership Team Improves Collaboration and Process Improvement Opportunities in an FM Department with 18 Clinics.”

“Developing a POCUS Faculty Credentialing Pathway: From Training to Practice” was the title of a poster co-authored by Dr. Leslie Stone, Dr. David Kelley, Dr. Stephen Foster, and Dr. Kraleti.

Dr. Germán Corrales (PGY2 in the Little Rock program) was lead author of “Telehealth Utilization for Opioid Use Disorder Analysis Before and After the COVID-19 Public Health Emergency Declaration” in the Fellows, Residents, or Students Research category. Kanna Lewis PhD and Dong Zhang PhD from DFPM RED were co-authors.

Dr. Stephen Foster and Kodi Liddell PharmD, BCPS presented “Advance Care Planning: Strategies to Improve Documentation and MIPS (Merit-Based Incentive Payment System) Metrics at an Academic Medical Institution.”

More details and photos are available on our Facebook page.

DFPM at STFM, May 2024

Filed Under: Department-Wide News, Residency

Dr. Lauren Gibson-Oliver Wins Award for Clinical Faculty Mentoring Excellence

Dr. Lauren Gibson-Oliver, Program Director of the UAMS Little Rock FM residency, has won the UAMS Clinical Emerging Faculty Mentoring Excellence Award for 2024.

Dr. Steven Webber, COM Dean, presented Dr. Gibson-Oliver with a crystal award at a ceremony in May. This award is presented annually to a junior faculty member who has made exemplary contributions to the professional development of faculty, staff, and students.

Gibson-Oliver wins mentoring award

Filed Under: Department-Wide News, Residency

Taren Swindle PhD of DFPM RED Wins Cancer Center Director’s Spotlight Award

Taren Swindle PhD, Associate Professor in the DFPM Research and Evaluation Division (RED), has won the UAMS Winthrop Rockefeller Cancer Center Director’s Spotlight Award for 2024.

​Dr. Swindle said she is honored to be selected for the award and to be involved in cancer prevention in Arkansas through her work in RED.

Taren Swindle PhD wins Cancer Center award

Filed Under: Department-Wide News, Residency

Dr. Leslie Stone Accepted to the 2024-2025 Executive Healthcare Leadership Program

Leslie Stone MD

Dr. Leslie Stone, DFPM Assistant Professor and Director of the Family Medicine Clerkship, has been accepted for the 2024-2025 Executive Healthcare Leadership Institute. 

​ A collaboration between the Walton School of Business and UAMS, the program provides inspirational and practical knowledge that academic medicine leaders need to succeed. Only 20 to 25 faculty members are accepted yearly for this honor.

Filed Under: Department-Wide News, Residency

Arkansas Medical Society Celebrates DFPM Faculty and Residents at Gala

The Arkansas Medical Society presented this year’s awards during their annual membership meeting and dinner gala on May 17.

Those receiving Faculty Academic Excellence Awards include Dr. Stephen Foster (Jonesboro) and Dr. Julea Garner (Baptist/UAMS NLR).

Resident winners include Dr. Amrutha Denduluri (Little Rock), Dr. Alexis House (Texarkana), Dr. Hamilton Newhart (Baptist/UAMS NLR), and Dr. Michael Page (Ft. Smith).

More details and photos are available on our Facebook page.

Filed Under: Department-Wide News, Residency

COM Sturgis Foundation Grant Awarded to Dr. Kraleti and Colleagues

The Sturgis Foundation Grant program of the College of Medicine is providing $31,146 to support a project titled “Increased Prescription and Utilization of Continuous Glucose Monitoring” and led by Dr. Shashank Kraleti.

His team on this project includes Dr. Stephen Foster, Kodi Liddell PharmD, BCPS, Dr. Lakshmi Menon (IM/Endocrinology), Kanna Lewis PhD, Andrea Hooten APR, MBA, and Marybeth Curtis RN, BSN, WOCN.

Filed Under: Department-Wide News, Residency

Dr. Tatiana T.C. Lino (PGY1) Wins AAFP Scholarship for Well-Being Conference

Dr. Tatiana T.C. Lino, a PGY1 resident in the UAMS Little Rock FM residency program, won a $1,000 scholarship from the AAFP to attend the Physician Health and Well-Being Conference in May in Arizona.

Dr. Lino says that the conference was a great experience that gave her new ideas to share with the residency’s Wellness Committee, of which she is a member.

Dr. Tatiana Lino AAFP scholarship

Filed Under: Department-Wide News, Residency

Three Medical Students Honored with Hedges Endowed Scholarships in FM 

This year’s Harold H. Hedges III MD Endowed Scholarships in Family Medicine have been awarded to three UAMS medical students who matched into FM residency programs throughout Arkansas.

The winners are listed below with a sampling of comments from their applications.

KENDALL BOOKER (UAMS Rural Track Program, Crossett): “I love the diversity and flexibility of Family Medicine. I could see myself returning to southeast Arkansas, practicing full scope Family Medicine and pouring back into the same community that built me.”

CHRISTOPHER BRAZEAL (Baptist/UAMS NLR): “I hope to be a Family Medicine doctor in a small town that is helping people live their best lives and maybe teaching future practitioners if things work out that way!”

​TONY ROLLER (UAMS Northwest Fayetteville): “With deep-rooted connections to Northwest Arkansas, I am eager to contribute to the wellness of my community and to serve this community long after residency.”

Filed Under: Department-Wide News

  • «Previous Page
  • Page 1
  • Page 2
  • Page 3
  • Page 4
  • Interim pages omitted …
  • Page 14
  • Next Page»
UAMS College of Medicine LogoUAMS College of MedicineUniversity of Arkansas for Medical Sciences
Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
Phone: (501) 686-7000
  • Facebook
  • X
  • Instagram
  • YouTube
  • LinkedIn
  • Pinterest
  • Disclaimer
  • Terms of Use
  • Privacy Statement

© 2025 University of Arkansas for Medical Sciences