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College of Medicine: Department of Family and Preventive Medicine

Community Health and Education

Helpful Reports – Middle School

To view this lesson plan as a PDF, click here. 

Objectives  

Students will:  

  • Learn what adults look for when reviewing a report.  
  • Distinguish between emotions and evidence-based details.  
  • Practice rewriting vague, dramatic, or incomplete reports into more helpful versions.  
  • Understand that the goal is support and safety, not punishment.  

Materials   

  • Mini-Lesson Google Slides: Link 
  • Student Paper: Link

Learning Activities  

Introduction  

  • In small groups, have students brainstorm answers to the following question: If you were reporting something anonymously, what information would you need to include?  
  • Bring class back together and share answers.   

Mini-Lesson  

Teach: A strong, appropriate report is:  

  • Clear (facts, not conclusions)  
  • Specific (details that help adults follow up)  
  • Respectful (no name-calling/slurs/judgments)  
  • Reliable (identifies what they saw/heard, not rumors)  

Provide appropriate examples and ask students what might be missing or not helpful about each example.   

Report Rewriting  

Give groups 4–6 sample anonymous reports with common issues:  

  • Overgeneralizing  
  • Emotional outbursts  
  • Missing key details  
  • Judgments instead of facts  
  • Rumors or “someone said that someone said…”  

Students provide missing information or rewrite to improve.   

Group Discussion  

Discuss:  

  • “How did you decide what details were important?”  
  • “What made a rewritten report more helpful and less emotional?”  
  • “Why shouldn’t we avoid reporting even if we’re unsure?”  

Notice of Federal Funding and Federal Disclaimer 

How We Keep Each Other Safe – High School

To view this lesson plan as a PDF, click here. 

Objectives 

Students will:  

  • Examine why communities require safe, confidential systems to address concerns.  
  • Understand the role of anonymous reporting in preventing harm and supporting wellbeing.  
  • Evaluate complex ethical situations involving safety, privacy, responsibility, and digital communication.  
  • Reflect on their values and responsibilities as members of a school community.  

Materials  

  • Student Paper: Link
  • Whiteboard for Whole Group Notes  

Lesson Activities  

Opening Reflection   

  • Ask students: “What is the difference between ‘getting someone in trouble’ and ‘getting someone help’?”  

Ethical Dilemmas Group Work   

Small groups analyze more complex scenarios.  

Groups answer:  

  • What harm is present or possible?  
  • Who is affected directly and indirectly?  
  • How could anonymous reporting support a safe outcome?  

Whole-Class Debrief   

Discuss themes:  

  • Fear of retaliation  
  • Loyalty vs. responsibility  
  • Safety culture  
  • Intervention vs. punishment  

Reinforce the idea: “Anonymous reporting is a tool for early support. It is not about punishment. It’s about care, prevention, and connecting people to resources.”  

Reflective Journaling  

Student Paper Written Prompt: 

  • “How can anonymous reporting empower students to protect each other?”   

Discussion Prompts:  

  • “Should safety ever outweigh privacy? When and why?”  
  • “How does digital communication change the risks and responsibilities of students?”  
  • “What kind of school culture makes reporting feel safe?”  
  • “What barriers might stop me or my peers from reporting concerns?”  

Notice of Federal Funding and Federal Disclaimer 

Helpful Reports – High School

To view this lesson plan as a PDF, click here. 

Objectives  

Students will:  

  • Understand how anonymous reports are evaluated for urgency and credibility.  
  • Analyze and correct vague, dramatic, or ambiguous reports.  
  • Practice creating reports that are concise, objective, respectful, and actionable.  
  • Reflect on ethical considerations: safety, privacy, bias, and appropriate use.  

Materials  

  • Mini-Lesson Google Slides: Link 
  • Student Paper: Link

Learning Activities  

Introduction  

  • Ask students: “What could happen if we don’t provide enough information in an anonymous report?”  

Mini-Lesson  

Explain that strong reports generally include:  

  • What you observed or heard (firsthand if possible)  
  • When it occurred (approx. time/date)  
  • Where it happened  
  • Why it concerns you  

Highlight respectful language and avoiding assumptions or diagnoses (“he’s crazy,” “she’s dangerous”).  

Provide anonymized, somewhat realistic samples. Students identify weaknesses such as:  

  • Emotional exaggeration  
  • Lack of detail  
  • Gossip/rumors  
  • Judgmental tone  

Report Rewriting  

With the student worksheet, give groups 4–6 sample anonymous reports with common issues:  

  • Overgeneralizing  
  • Emotional outbursts  
  • Missing key details  
  • Judgments instead of facts  
  • Rumors or “someone said that someone said…”  

Group Discussion  

Discuss:  

  • “Why is clarity important but not required for reporting?”  
  • “How do we avoid unintentionally shaming or labeling someone?”  
  • “Why is reporting still encouraged even if your description isn’t perfect?”  

Emphasize: It is always better to report than to stay silent. Adults can sort through details; students don’t need to investigate.  

Notice of Federal Funding and Federal Disclaimer 

Scenario Sort – High School

To view this lesson plan as a PDF, click here. 

Objectives  

Students will:  

  • Evaluate complex, nuanced safety‑related scenarios.  
  • Determine when an anonymous report is the safest, most ethical action.  
  • Explore issues of confidentiality, stigma, personal responsibility, and digital citizenship.  
  • Understand how anonymous reporting complements direct communication or adult involvement.  

Materials  

  • Student Paper: Link

Learning Activities  

Small Group Sort  

  • On student paper, have student sort scenario cards into anonymous reporting, trusted‑adult conversations, and non‑reportable events.  

Class Discussion  

Bring class back together. Discuss:  

  • “How do we balance someone’s privacy with the need to protect them?”  
  • “When is anonymous reporting the most responsible choice?”  
  • “What could happen if we misjudge a situation as ‘not serious’?”  

Emphasize: 

  • Anonymous reporting exists to prevent harm, protect bystanders, and support mental health.  
  • It is part of a larger safety system including adults, peers, and trusted communication.  

Optional Exit Ticket  

  • Have students answer the following question: “How will you decide in the future to decide if something should be reported anonymously?”  

Notice of Federal Funding and Federal Disclaimer 

Notice of Federal Funding and Federal Disclaimer 

This Web site is funded in whole or in part through a grant from the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice. Neither the U.S. Department of Justice nor any of its components operate, control, are responsible for, or necessarily endorse, this Web site (including, without limitation, its content, technical infrastructure, and policies, and any services or tools provided).

How Early Screening Helps Primary Care Clinicians Uncover Youth Substance Use

Ninety percent of people addicted to substances started drugs before they were 18, and anxiety, depression and even suicide are often linked with addiction. That’s why early detection is crucial, said Caitlyn Johnson and Kim Shuler, licensed social workers with Arkansas Behavioral Health Integration Network.

They presented evidence-based adolescent substance use screening tools such as the SBIRT model (Screening, Brief Intervention and Referral to Treatment) at the UAMS 29th Annual Family Medicine Update Oct. 29, 2025.

The event was sponsored by the UAMS Department of Family and Preventive Medicine’s Community Health and Education division. Arkansas Children’s National Center for Opioid Research and Clinical Effectiveness sponsored the first day, “Opioids and the Young.”

Speakers Caitlyn Johnson and Kim Shuler, both social workers with the Arkansas Behavioral Health Integration Network
Caitlyn Johnson and Kim Shuler with Arkansas Behavioral Health Integration Network

Trends in Teen Substance Use: Alcohol Still Leads

The social workers surprised the primary care audience by revealing that alcohol trumps nicotine and THC as adolescents’ most used substance because it is readily accessible and culturally accepted. But the good news is that binge drinking is trending down, according to the National Institute on Drug Abuse, even though it’s still a contributor to 74% of premature deaths among teens.

“Substance use can contribute to feeling more uninhibited and having suicidal thoughts,” said Shuler. “Suicide is something that we need to have in the forefront of our minds.”

How SBIRT Works in Primary Care

“The key is to be as preventative as possible and provide education and tools for these teens,” Johnson added, referring to SBIRT, which stands for screening, brief intervention and referral to treatment. SBIRT screening tools often take five minutes or less to administer. Substance Abuse and Mental Health Services Administration (SAMHSA) recommends starting at age 12, but children as young as 10 are using substances

“Think about using universal screening for substances, meaning at every visit, use a screener. One of the things we know is that sometimes, when we’re asking someone (about their substance use), they may not tell us the first time. So, it’s important to continually bring this up,” said Shuler.

SBIRT - The 35,000 Foot View Screening, Brief Intervention and Referral to Treatment (SBIRT) is one of the leading ways to reduce the impact of alcohol and substance use. Screening - Identifying adolescents who are at risk of negative consequences due to their substance use, including risk of a substance use disorder. Brief Intervention - A conversation that is intended to either prevent, stop or reduce substance use disorder. Referral to Treatment and Follow-up -- Linking the adolescent to substance use disorder treatment and other services, resources and supports and regularly checking in to facilitate sustained access.

The CRAFFT is one of the more common screening tools. There are others such as anxiety screener Generalized Anxiety Disorder, called GAD, and the PHQ-9A which screens for depression.

Whatever tool is chosen, it’s important to let the teen know that the provider is asking everyone about substance use and not singling them out. The provider must establish confidentiality, that the patient can be honest and trust them.

Clinicians should talk with the parent or caregiver first, conveying the importance of the screening and the need for confidentiality. This will settle the parent’s mind when asked if the teen can step out for a few minutes to speak privately.

Once that confidentiality is set, what if the young patient answers “yes” to any of the questions on the screener? Johnson said many providers feel they don’t have the tools to take the next step of intervention. One solution is to hire behavioral health consultants in the clinic, but providers have been hesitant to move to integrated care because of financial, training and space issues. Video on Arkansas providers who are taking the step toward behavioral health integration.

Brief Intervention Steps

teen boy talking to provider in office visit
Chances of developing an addiction are six times higher for teens who began using before age 15 than those who delay use until they’re 21.

Johnson and Shuler walked through the conversational steps for brief intervention when a behavioral health professional isn’t available.

If the CRAFFT screening score is low (0-2), the intervention may require only one to three minutes since the patient is low risk. If moderate to high risk, the intervention will take 15 – 30 minutes. Johnson said to allot enough time to complete the intervention.

“There are barriers to seeing the doctor, such as missing school and insurance being able to pay and things like that. So you want to make sure you give as much as you can in one session,” said Johnson. She added that the intervention can be extended to several sessions with either the provider or medical team. “If you run into an adolescent or young adult that is not ready to make behavior change, that is OK. That’s to be expected. Their brains are still developing, and they are learning how to make those educated decisions,” said Johnson.

The social workers covered a step-by-step example of brief intervention called the Brief Negotiated Interview model, created by the Boston University School of Public Health. It has six stages.

    1. Build engagement and rapport – Show interest in them as a person, the things they’re putting in their body and the risks. “Would it be OK if we spent a few minutes talking about your alcohol or drug use?” If “yes,” go to question two, but if the answer is “no,” offer to be available to talk if needed.
    2. Pros and Cons – Ask what is enjoyable about using the substance and what’s difficult. “What else comes to mind when you think about how using the drug may impact your life, goals or wellbeing?”
    3. Feedback – Ask if they mind some education or thoughts on the situation. If “yes,” share one or two facts and ask their thoughts. If “no,” emphasize autonomy by saying the patient knows what’s best for them regarding the drug use.
    4. Readiness Ruler – Gauge their motivation for change, whether it’s low on the scale or high, and what can be done about it. “If you were to place yourself on a scale of 1 – 10 regarding how important it feels to make any change in your use of the drug, where would you be?” If the answer is four or above, ask why they chose that number and not a lower one. If the answer is 1 – 3, probe with the question, “What would have to happen to feel like making a change?”
    5. Negotiate Action Plan – Formulate goals with them. “So, now that we’ve had a few minutes to talk, what would you like to do, if anything? Would it be OK if I share some options?” Have them write down their goals and next steps. Focus on one to two short-term goals with specific steps.
    6. Summarize and Thank – They took a chance on being vulnerable with the provider, which can be painful. Ask, “Is this what you agree we went over? How do you feel about these goals that we set?”

    Shuler noted that one powerful preface to a question is, “I’m curious,” because curiosity invites openness and doesn’t equal judgment.

    When to Refer for Substance Use Treatment

    If the brief intervention reveals a need for more intensive care, Johnson said the referral needs to be to a licensed substance use professional at a treatment facility. Cost, insurance, school or parents’ work schedule are some potential barriers.“It’s not going to be the smoothest process,” said Johnson, “but it is worth a try to see if we can overcome those barriers through conversations or connections to resources.”

    The Arkansas Department of Human Services Office of Substance Abuse and Mental Health oversees prevention, treatment and recovery programs in the state and can help locate providers by area.

    An educational video from Dr. Aaron Weiner on youth substance use and mental health.

    Kim Shuler, LCSW, has more than 20 years of experience in clinical practice and leadership within integrated behavioral health. As CEO of ABHIN and project director for several HRSA-funded initiatives, she leads statewide efforts to advance access and quality. She is a certified behavioral health consultant with expertise in workforce training, coalition-building and strategic planning.

    Caitlyn Johnson, LCSW, has 10 years of experience in integrated behavioral health, care coordination and medical social work. She earned her bachelor’s and master’s degrees in social work from the University of Arkansas at Little Rock and serves as a project manager on multiple grants for the Arkansas Behavioral Health Integration Network. Johnson specializes in program development, brief intervention, harm/stigma reduction and suicide prevention.

    Family Medicine Update Oct. 29 – 31 offers 12 hours of virtual content for primary care

    The 29th Annual Family Medicine Update: Fueling the Front Line will offer up to 12 hours of online continuing education Oct. 29 – 31 for primary care physicians, advanced practice registered nurses and registered nurses, pharmacists, physician associates, physical therapists, respiratory therapists, certified health educators, social workers and substance abuse counselors.

    The virtual annual conference compiles the latest advances impacting family medicine, with a bonus of flexible, on-demand viewing through November 28, 2025.

    The first day – Opioids and the Young – offers four hours of content for only $25. The Thursday and Friday two-hour blocks are $40 each.

    To register, visit this link.

    Day 1

    The first day is Opioids and the Young, sponsored by Arkansas Children’s National Center for Opioid Research and Clinical Effectiveness. The day will include a talk on opioid use disorder in moms and children with Shona Ray-Griffith, M.D., an associate professor in the UAMS Depts. of Psychiatry and Obstetrics and Gynecology, and mandated reporting laws with Jessica Coker, M.D., assistant professor in the UAMS Dept. of Psychiatry. Other topics include behavioral health screening and intervention for adolescents with Kim Shuler, LCSW, and Caitlyn Johnson, LCSW, both with the Arkansas Behavioral Health Integration Network. The last session will be “Opioids Off the Table? Now What?” with Teresa Hudson, Pharm.D., Ph.D., a professor in the UAMS Dept. of Psychiatry.

    Caitlyn Johnson and Kim Shuler, social workers
    Caitlyn Johnson and Kim Shuler

    Day 2

    Talks on the second day will feature UAMS providers: sniffles, chills and fever in kids with Rachel Ekdahl, M.D., and Satvika Mikkilineni, D.O.; “Naloxone Know-How for Saving Lives” with Leah Tobey-Moore, DPT, MBA, and Meghan Breckling, Pharm.D.; and a fresh look at hypertension medications with Michelle Hernandez, Pharm.D. Alexis White, M.D., also will speak on menopause.

    Alexis White, MD
    Alexis White, M.D.

    Day 3

    The last morning of the virtual conference will focus on cancer screening in Arkansas, presented by Daniele Ramirez-Aguilar, MPH, with the Arkansas Central Cancer Registry, and “Mending a Child’s Heart: Pediatric Cardiology from a Nurse Practitioner Perspective” with Leslie Lewis, APRN, who works at Children’s Medical Center in Dallas, Texas. The two afternoon sessions will feature Robert Hopkins Jr., M.D., who will update attendees on immunization essentials for the fall. He is the division director for the UAMS Dept. of Internal Medicine. Next will be “Spotlight on LADA: The Hybrid Diabetes of Adulthood” with Hadeel Al Fares, M.D., an endocrinology, diabetes and metabolism fellow at UAMS.

    Robert Hopkins Jr., M.D.

    Family Medicine Conference Warns of Trend for Early-Onset Colorectal Cancer and Highlights Topics Important to Family Medicine

    Family medicine providers gathered for UAMS’ virtual 2025 Family Medicine Spring Review April 23 -25 and learned that the colorectal cancer death rate in people younger than 55 is climbing one percent each year since the mid-2000s, but that this group is more open to a yearly stool-based screening test such as the fecal immunochemical test (FIT) or Cologuard than other age groups.

    The colorectal cancer screenings updates from Whitney Jones, M.D., a gastroenterologist from Kentucky, and Francis Colangelo, M.D., a primary care physician with Allegheny Health Care in Pittsburgh, were part of the first day of the three-day conference.

    Francis Colangelo, M.D. talking with Family Medicine Spring Review logo on the side.
    Francis Colangelo, M.D., primary care physician, speaking on early-onset colorectal cancer.

    “Around 41 percent of these (younger patients) had symptoms for at least six months before visiting a provider,” said Colangelo. “And if you see rectal bleeding, always assume it is colorectal cancer in the younger patient.”

    The conference was presented by the Department of Family and Preventive Medicine’s Community Health and Education division, which has produced continuing medical education for 47 years.

    Amanda Deel, D.O., associate dean of the New York Institute of Technology’s College of Osteopathic Medicine, spoke on compassion in healthcare.

    “Following a compassion-centered script with patients may feel artificial, but in a study, patients didn’t sense that. Physicians miss opportunities to practice compassion 70 percent of the time and interrupt patients on average in the first 11 seconds,” said Deel.

    Angela Driskill, M.D.
    Angela Driskill, M.D.

    Angela Driskill, M.D., is a wound care specialist practicing at Baptist Health. She said there must be a distinction between pressure injuries and skin that fails because pressure injuries imply failure of care or harm.

    “If you don’t document a wound 12 to 24 hours after admission, it will throw up a red flag to CMS. Say it’s been 24 hours before anyone does a skin assessment, they are classified as ‘unwounded’ when they came in. Then we document there’s a stage 3 or 4 wound of the sacrum, and CMS begins to recoup the cost of that care, which can be $50,000 to $70,000,” said Driskill.

    Sleep medicine physician Caris Fitzgerald, M.D., offered trouble-shooting tips for patients who wear a CPAP, a machine that treats sleep apnea with continuous positive airway pressure. CPAP manufacturers estimate that more than eight million people wear a CPAP each night. One common complaint is dry mouth.

    Picture of Caris Fitzgerald, MD
    Caris Fitzgerald, M.D.

    “A leak makes or breaks the experience with a CPAP,” said Fitzgerald, who sees patients at the Central Arkansas Veterans Healthcare System. “If a patient complains of dryness, fix the leak, don’t just increase the humidity. The nose is a humidifier. If your pressure system is sealed well and the patient is nasal breathing, they will not need a humidifier.”

    My goal with patients is 10LPM unintended leak. 10LPM is generally a good goal for 95% Unintended Leak. Most under 10LPM can do without a humidifier which means a lot less cleaning and expense. And those with co-occurring good use have almost always resolved the complaints associated with OSA.

    In his talk on metabolic issues, James Tucker, M.D., bariatric surgeon with Arkansas Heart Hospital, said bariatric surgery is not a cure for disease of obesity but a treatment. Sleeve gastrectomy is the more common surgery where 50 to 70 percent of the stomach is removed.

    “With insulin-dependent patients who’ve had the surgery, 60 percent to 80 percent experience remission from the disease,” said Tucker.

    On the third day of the conference, Amy Grooms, M.D., with the UAMS Department of Psychiatry, spoke about using transcranial magnetic stimulation for patients with treatment-resistant depression. She said transcranial magnetic stimulation uses a magnetic pulse that stimulates the dorsolateral prefrontal cortex and rebalances it with the subgenual anterior cingulate cortex. Around 30 percent of patients who use this treatment have a standard response, but 18 percent of patients report that their depression is gone.

    Bill Fantegrossi, M.D.
    Bill Fantegrossi, M.D.

    Bill Fantegrossi, Ph.D, who works in the UAMS Department of Pharmacology and Toxicology, ended the conference with a talk on emerging drugs of abuse. He said new synthetic opioids grip more tightly to the opioid receptors in the brain. With such a strong bond, reversing an overdose is difficult with standard treatments such as naloxone (Narcan). Naloxone knocks opioids from brain receptors, but it struggles to unbind new synthetic opioids from receptors. This means it can only partially reverse an overdose or may fail.

    Synthetics - fentanyls. Lethal doses of heroin, fentanyl and the ultra-potent analog carfentanyl.

    Other conference topics included an update on the HPV vaccine with Portia Knowlton, who works with St. Jude’s HPV prevention program, renal cysts and masses with UAMS’ Marcelo Bigarella, M.D., and long-term effects after curative cancer treatments with Viriginia Laliberte, APRN. Ashley Acheson, Ph.D., and Jami Jones, who work with the National Center for Opioid Research & Clinical Effectiveness at Arkansas Children’s Hospital, spoke on the research they are conducting on children and adolescents who have been affected by the opioid crisis and other drug addictions.

    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.

    Physician Wins Award for High Colorectal Cancer Screening Rate

    Dr. Clinton Smith with 1st Choice Healthcare was named the Arkansas Cancer Coalition Healthcare Provider of the Year at the Arkansas Cancer Summit March 7 for his 75 percent rate of colorectal cancer screening with his patients.

    The family physician has participated in the UAMS Partnerships in Colorectal Cancer Screening for Arkansas (PiCS-AR!) since 2020, a Centers for Disease Control and Prevention grant that seeks to raise colorectal cancer screening rates in the state. His 75 percent rate is closing in on the national goal of 80 percent set by the National Colorectal Cancer Roundtable.

    Clinton Smith, DO
    Clinton Smith, DO, physician with 1st Choice Healthcare in Corning, Arkansas

    Smith’s first year with the PiCS-AR! grant showed a screening rate of 65 percent. His rate grew to 70 percent in 2021 and has escalated in one year to 75 percent.  He said the reasons for his higher screening rate stem from frequently reminding the patients of screening, making it easy for them to screen, and relaying the facts.

    “Each time I have a checkup with a patient (not even necessarily a wellness checkup), I try to mention (screening) and see if they’re due for anything. And if they are, we try to go ahead and facilitate that and get it set up,” said Smith. “The best time to (mention) it, in my opinion, is when you see them. Sometimes people are non-compliant and you may not see them for a while.  Now, it does take extra time, and sometimes I get behind, but I feel that prevention is the key.  It’s better to prevent a problem than to have to treat it later.”

    Smith gives his patients several screening options: stool-based tests and a colonoscopy. The stool-based tests (FIT or Cologuard) require that the patient send a sample of their stool in the mail, which takes minutes and is not invasive and requires no dieting, fasting or anesthesia. The colonoscopy is considered the most accurate for colorectal cancer screening, but with his rural patient population in northeast Arkansas, arranging a colonoscopy can be cost- and time-prohibitive.

    “I tell them about the options and let them decide. I think the FIT tests have helped a lot. We’re rural, so to get a colonoscopy, you not only have to take a day off of work, you have to drive 30 miles outside of town,” said Smith.

    Colorectal cancer is the second deadliest cancer for Americans, and it’s on the rise with younger age groups, according to the American Cancer Society. The rate of new colorectal cancer cases among Americans younger than 55 increased from 11 percent of all cases in 1995 to 20 percent in 2019.  The recommended screening age for those with average risk is 45, which the U.S. Preventive Services Task Force lowered from age 50 two years ago because of this new trend. Screening at an earlier age means cancer will be caught in its first stage and is highly treatable if detected early.

    Smith also credits his employer, 1st Choice Healthcare, for allowing him to spend more time with his patients who are often chronically ill and require more than the suggested 15 minutes many physicians are tethered to. 1st Choice is one of two healthcare partners working with the PiCS-AR! five-year grant. Mid-Delta Healthcare System in eastern Arkansas is the latest system to join.