Screening for Comorbidities in Patients With Hidradenitis Suppurativa

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, recurring, inflammatory disorder of the hair follicles in intertriginous and anogenital regions of the body.^1,2 Characteristic lesions of HS include painful inflammatory nodules, subcutaneous abscesses, comedones, tunneling sinus tracts, and hypertrophic scarring.^1,2

The chronic and recurring nature of HS and long-term sequelae (eg, skin contractures, chronic pain, and disfigurement) may have a profound negative impact on quality of life and have established HS as one of the most debilitating dermatologic conditions.^1,3

Prevalence and Etiology of Hidradenitis Suppurativa

Hidradenitis suppurativa affects approximately 1% to 2% of the US population and is more commonly seen in women, Black patients, and patients between 20 and 40 years.²

The etiology of HS is not clear, although a combination of factors are thought to be involved in the pathophysiology of the disorder, including aberrant immunity, hormonal dysregulation, and genetic predisposition.^1,2

Several comorbidities are associated with HS, including metabolic disease, diabetes, polycystic ovarian syndrome (PCOS), cardiovascular disease, current or past smoker, squamous cell carcinoma, and anxiety/depression.² Reddy et al found a 2-fold increase in overall comorbidity burden, as measured using the Charlson Comorbidity Index (CCI), in patients with HS.⁴ The CCI is a validated standardized measure of global comorbidity and is associated with short- and long-term mortality across various populations in the outpatient setting.^4,5 

A significant portion (13.5%) of patients with HS in the study had a CCI score of 5 or greater, which was associated with a nearly 5-fold increase in 5-year mortality risk compared with patients with HS and a CCI score of 0.⁴ The degree of morbidity burden and increased mortality among HS patients suggests the need for multidisciplinary implementation of screening measures that support prevention and early detection in this population.⁴

Until recently, formal guidelines for the management of HS have been limited; however, the North American and Canadian Hidradenitis Suppurativa Foundations recently released guidelines for clinical evaluation, treatment, and management of this disease. Comorbidity screening is a key element of these guidelines (Table 1).²

Table 1. Guidelines for Comorbidity Screening in Hidradenitis Suppurativa²

Step	Recommendation
Perform review of systems and physical examination	Screen for metabolic syndrome, depression, anxiety, type 2 diabetes, PCOS, and tobacco abuse
Identify patients with additional diabetes risk factors	Refer patients with risk factors for diabetes (eg, obesity, hypertension, hyperlipidemia, and acanthosis nigricans) for HbA1c and/or fasting glucose testing
Screen for comorbidities	Screen for depression, inflammatory bowel disease, autoinflammatory syndromes, and inflammatory arthropathy based on review of systems

This article originally appeared on Clinical Advisor