192 Diagnostic delay in hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS) is an oftentimes devastating condition affecting the intertriginous areas. Patients are often reluctant to seek care, resulting in delayed diagnosis and treatment. An online REDCap survey explored associations between delayed treatment seeking and physical and psychological factors of 153 HS participants [mean age: 37.4yrs (std 12.3), range: 16-73yrs; 87% female; mean BMI: 33.1 (8.9); 66.2% Caucasian, 14.3% Hispanic, 8.5% African American]. The mean age of disease onset was 20.4yrs (9.96) and of HS diagnosis was 32.3yrs (12.5). Using multiple regression, higher BMI, male gender, younger age at first lesion, and Caucasian ethnicity were significantly associated with increased time between disease onset to seeking treatment (p<0.05). Misdiagnosis contributed to delay in diagnosis; HS was misdiagnosed as abscess (50.3%) or cyst (44.8%), acne (31.5%), cellulitis (14.7%), or MRSA (13.3%). Other reported reasons for delay in seeking care included belief that lesions would resolve (51.7%) or that treatment was unavailable (30.1%), and embarrassment (33.6%), suggesting a sincere knowledge gap and lack of support in our cohort. Of patients in a relationship, 49.7% were reluctant to discuss HS with their partners, with 26.1% stating that HS greatly interfered with their sexual relationships (7.3/10-point on Likert scale). Contrary to previous reports of a 7.2yr global diagnostic delay, with a more significant delay seen in women and patients with moderate-severe HS [1], our data broadly identifies a potentially longer global diagnostic delay (12yr), and that BMI, male gender, early-onset HS, and Caucasian ethnicity are associated with longer delays. Delayed care may worsen physical sequela and create long-lasting psychological stress related to sexual intimacy. Though misdiagnosis and delay in seeking care may be related to evolution of disease, efforts for dermatologists and PCPs to psychologically support, educate, and engage HS patients should be undertaken.