91. Association of Pilonidal Disease with Polycystic Ovarian Syndrome in Adolescent Females

Abstract

<h3>Background</h3> Polycystic Ovarian Syndrome (PCOS) and Pilonidal Disease (PD) have been associated with a number of dermatologic conditions such as hirsutism, acne, seborrheic dermatitis, androgenetic alopecia, psoriasis and hidradenitis suppurativa. These conditions share similar risk factors including obesity, elevated androgens and metabolic syndrome. There is scant evidence about association between PCOS and PD. Prevalence of PD in adolescents is 0.7% and of PCOS is 8 to 13%. Pilonidal disease and PCOS are associated with significant morbidity and decreased quality of life, thus early diagnosis and treatment are important. We sought to determine whether pilonidal disease is associated with PCOS and whether severity of PD is greater in patients with concurrent PCOS and whether treatment of PCOS reduces pilonidal disease severity. <h3>Methods</h3> This was a retrospective chart review approved by the Institutional Review Board. Inclusion criteria was all girls aged 12 to 21 receiving a diagnosis of PCOS or PD from 2012-2019 at a tertiary medical center. Variables analyzed included age, race/ethnicity, BMI, menarche, tobacco use, payer status, treatment of PCOS and PD, serum markers of hyperandrogenism and metabolic syndrome. Data was analyzed with Student's t-test, chi-squared test, and multiple logistic regression <h3>Results</h3> In total, 100, 043 patients presented to an urban tertiary medical center with 769 patients diagnosed with PD of which 209 patients were diagnosed with both PD and PCOS. Patients with both diagnoses were more likely to have a higher BMI (31.4 v. 27.4, p<0.01), and be older (18.8 v. 18.3, p=0.04). The odds of patients with PD having PCOS was 34.6 times that of patients without PD [CI 29.2,40.9] (p<0.001). Patients with both diagnoses were less likely to receive intervention for PD (OR 0.22 [CI 0.13,0.37] (p<0.001)). Subgroup analysis of patients age < 18 years reduced confounding due to age and payer status. <h3>Conclusions</h3> There is a higher prevalence of PCOS among adolescent girls diagnosed with PD. PCOS treatment appears to confer a protective effect in reducing risk of intervention for PD. Increased awareness of the association between PCOS and PD among providers taking care of female adolescents with PD should result in lower threshold for screening for PCOS and/or referral to adolescent gynecology for further evaluation. If future studies involving diverse population show replicability of these findings, formalized practice guidelines aimed at screening for PCOS in girls presenting with PD should be developed. This approach may improve early detection and ultimately treatment of PCOS.