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Keratoacanthoma — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSkin CancerKeratoacanthomaSCE Dermatology

At week 16 of secukinumab for hidradenitis suppurativa, abscess plus inflammatory-nodule count has fallen from 20 to 15. Abscesses remain at 2 and draining fistulas remain at 3. Which NICE decision follows?

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Correct answer: E — Continue because the total count fell by 25% without either worsening component

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

C is correct. The combined count has fallen by 5 of 20, exactly 25%, while neither abscesses nor draining fistulas have increased. This meets the NICE TA935 continuation rule. The commissioned threshold is HiSCR25, not the trial endpoint HiSCR50, and complete fistula closure is not required. DLQI, pain and patient experience remain important, but TA935 does not substitute a five-point DLQI rule for the lesion-count requirement. Prior adalimumab failure or unsuitability is part of eligibility, not a reason to stop an otherwise responding course.

Reference: NICE TA935: secukinumab for hidradenitis suppurativa: https://www.nice.org.uk/guidance/ta935/chapter/1-recommendations