Hidradenitis Suppurativa Carries Heavy Comorbidity Burden

Hidradenitis Suppurativa
Hidradenitis Suppurativa
There is a substantial burden, unawareness, and undertreatment of several systemic comorbidities—particularly cardiovascular and psychiatric—in patients with HS.

Several systemic comorbidities, including cardiovascular (CV) and psychiatric comorbidities, are present in patients with hidradenitis suppurativa (HS), and many CV comorbidities go unrecognized or are undertreated, according to study data reported in the Journal of the European Academy of Dermatology and Venereology.

A total of 302 consecutive newly referred patients with HS who attended a tertiary care center in Denmark were enrolled in the study. Patients underwent interviews and examinations to identify several systemic comorbidities, including hypertension, dyslipidemia, diabetes, obesity, inflammatory bowel disease, arthritis, psychiatric disease, psoriasis, obstructive lung disease (asthma/chronic obstructive pulmonary disease [COPD]), and polycystic ovary syndrome (PCOS). Information on smoking, employment status, age at HS onset, HS severity as measured by Hurley stage, and the presence of HS in a first-degree relative was also collected.

The majority of patients with HS included in the sample had ≥1 comorbidity (86.6%), with an average of 2.1 comorbidities per patient. There was evidence of significant unawareness and undertreatment of CV comorbidities in the 76.5% of patients with HS who had ≥1 CV comorbidity. A smaller percentage of patients had inflammatory bowel disease (6.6%), arthritis (6.3%), psoriasis (5.6%), obstructive lung disease (7.9%), and polycystic ovary syndrome (6.6%). Less than one-third of patients (29.5%) had a psychiatric diagnosis.

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In an analysis that included all 10 comorbidities, there was a higher mean number of comorbidities with increasing Hurley stage (1.8 vs 2.1 vs 2.4 for Hurley I vs II vs III, respectively; P =.058) and for the four CV-related comorbidities (hypertension vs dyslipidemia vs diabetes vs obesity; 1.3 vs 1.4 vs 1.9, respectively; P =.006). Significant predictors for the onset of diabetes in these patients included age (per year; hazard ratio [HR], 0.87; 95% CI, 0.79-0.96; P <.006), age at onset of HS (per year; HR, 1.26; 95% CI, 1.14-1.40; P <.001), male sex (HR, 2.51; 95% CI, 0.88-7.16; P =.086), Hurley stage III vs Hurley I and II (HR, 3.46; 95% CI, 1.25-9.58; P =.017), body mass index (per unit; HR, 1.12; 95% CI, 1.04-1.20; P =.002), and blood glucose (per unit; HR, 1.27; 95% CI, 1.16-1.39; P <.001).

A study limitation was the use of an unvalidated questionnaire to identify an HS diagnosis rather than a clinical diagnosis confirmed by a dermatologist.

Of note, it was observed that a high degree of unawareness and undertreatment of

CV risk factors and psychiatric comorbidities exist in patients with HS. According to the investigators, the findings from this trial “highlight the need for a multidisciplinary collaboration between dermatologists and other specialties.”

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Jørgensen AR, Yao Y, Ghazanfar MN, Ring HC, Thomsen SF. Burden, predictors and temporal relationships of comorbidities in patients with hidradenitis suppurativa: a hospital-based cohort study [published online August 23, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15904