Diagnosis Of Hidradenitis Suppurativa Research Articles

Low Rates of Psychosocial Screening and Lifestyle Counseling in Hidradenitis Suppurativa Patients in the USA

Introduction: Although hidradenitis suppurativa (HS) is associated with psychosocial comorbidities such as depression as well as modifiable comorbidities such as obesity, rates of psychosocial screening and lifestyle counseling in the USA have not been characterized. Methods: This cross-sectional study utilized publicly available data from the National Ambulatory Medical Care Survey (NAMCS) between 2008 and 2018 to identify visits with a diagnosis of HS (ICD-9 code 705.83, ICD-10 code L73.2). T tests and multivariate logistic regressions analyzed trends in rates of screening and counseling while controlling for race, sex, and age. Survey weights are applied to each visit to represent a national sample. Results: Depression screening was completed in only 2% of reported visits. No visits reported screening for alcohol misuse, substance abuse, or domestic violence. There were low rates of counseling for weight reduction (7.8%), diet and nutrition (3.3%), exercise (2.4%), smoking (1.0%), and substance abuse (0.7%). Black patients and individuals with public health insurance received less screening and counseling overall. Conclusion: Rates of psychosocial screening and counseling on lifestyle modifications are low in ambulatory clinic visits for HS patients, and there are disparities based on race and insurance status. Implementing strategies to incorporate routine psychosocial screening and lifestyle counseling into visits may improve HS patient outcomes.

Hidradenitis suppurativa diagnosis and management in primary care: not just recurrent boils.

Hidradenitis suppurativa (HS) is characterised by inflamed skin lesions and scars that occur in apocrine-gland-bearing areas including axillae, inframammary folds, and groin, with a chronic course including flares.1 It is associated with an average diagnostic delay of 7.2 years and has a Western population prevalence of approximately 1%–2%.2,3 HS affects young to middle-aged adults and is more common in women. It is 2–3 times more common in people with skin of colour especially those of African American descent.2 HS significantly impacts general health and quality of life. A recent cross-sectional survey of GPs found that, while patients were largely managed appropriately, there was suboptimal management of pain, psychosocial aspects, and comorbidity screening.4 The current article aims to address this educational need. Historically, HS was poorly recognised and under-researched. Patients are often treated sub-optimally and comorbidities are not managed. Practitioners in primary care can both diagnose and treat early disease. They can address comorbidities, support lifestyle changes, and offer psychological support. Three main elements need to be considered in a diagnosis of HS:

Phenotype Algorithms to Identify Hidradenitis Suppurativa Using Real-World Data: Development and Validation Study.

Hidradenitis suppurativa (HS) is a potentially debilitating, chronic, recurring inflammatory disease. Observational databases provide opportunities to study the epidemiology of HS. This study's objective was to develop phenotype algorithms for HS suitable for epidemiological studies based on a network of observational databases. A data-driven approach was used to develop 4 HS algorithms. A literature search identified prior HS algorithms. Standardized databases from the Observational Medical Outcomes Partnership (n=9) were used to develop 2 incident and 2 prevalent HS phenotype algorithms. Two open-source diagnostic tools, CohortDiagnostics and PheValuator, were used to evaluate and generate phenotype performance metric estimates, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value. We developed 2 prevalent and 2 incident HS algorithms. Validation showed that PPV estimates were highest (mean 86%) for the prevalent HS algorithm requiring at least two HS diagnosis codes. Sensitivity estimates were highest (mean 58%) for the prevalent HS algorithm requiring at least one HS code. This study illustrates the evaluation process and provides performance metrics for 2 incident and 2 prevalent HS algorithms across 9 observational databases. The use of a rigorous data-driven approach applied to a large number of databases provides confidence that the HS algorithms can correctly identify HS subjects.

Pain experiences among those living with hidradenitis suppurativa: a qualitative study.

Pain is rated by patients with hidradenitis suppurativa (HS) as the disease's most impactful symptom. HS therapies are often insufficient to control inflammatory disease activity and pain. A better understanding of patient experiences with pain may improve patient-provider relationships and help identify strategies for addressing HS pain. This qualitative study sought to characterize lived pain experiences of those with HS. English-speaking patients ≥ 18 years old with a dermatologist-confirmed diagnosis of HS and an average numerical rating scale pain score of ≥ 1 over the preceding week were recruited from a single academic medical centre in Atlanta, Georgia, USA. Semistructured interviews were conducted from November 2019 to March 2020 to explore participants' HS pain experiences and the subsequent impact on their lives. Thematic saturation was reached after interviewing 21 participants. Interviews were audio recorded, transcribed, and analysed using thematic analysis. Among 21 study participants, the median 7-day average pain score was 6 (interquartile range 3-7; scale ranges from 0 to 10, with 10 being most pain). Participants' descriptions of pain were consistent with nociceptive pain, neuropathic pain and itch. Pain impacted multiple life domains, including physical limitations (decreased mobility and impaired sleep), decreased psychological wellbeing (irritability, depression, loss of control, and difficulty communicating pain experiences) and impaired social relationships (social isolation, intimacy problems and difficulty fulfilling social responsibilities). Although participants reported chronic discomfort, acutely painful and unpredictable HS disease flares caused more distress and quality-of-life (QoL) burden. Participants frequently treated their pain without input from the medical team, sometimes with unsafe medication doses or combinations. Factors contributing to self-management of pain included difficulty accessing timely outpatient care during disease flares and fear of stigma from healthcare providers. When present, HS-related pain may impact not only physical wellbeing but also mental health and relationships. In addition to therapies that target the inflammatory disease burden, treating the symptom of pain may improve patients' QoL and wellbeing. Because patients with HS have difficulty explaining their pain, proactively asking them about pain may identify unmet needs, facilitate better pain control and improve QoL. Further, the influence of HS-related pain on numerous aspects of QoL suggests the need for multidisciplinary, patient-centred approaches to HS pain management.

Impact of hidradenitis suppurativa-specific wound dressing system on patient quality of life and dressing-related pain: pilot study.

It is theorised that adhesive-free wound care developed specifically for patients with hidradenitis suppurativa (HS) can improve their quality of life (QoL). Our study aimed to investigate the impact of a novel wound care device on Dermatology Life Quality Index (DLQI) scores, and other factors related to experienced pain, time spent changing dressings, comfort, ease of use and body image. A 21-day, single-arm, unblinded, pilot trial was conducted to assess ease of use and the impact of effective wound care on various aspects of wound management in patients with HS. Participants were provided two trial garments and trial dressings as required, to use over a 21-day period in the home setting. A seven-item questionnaire and the DLQI questionnaire was completed on days 0, 7, 14 and 21. All 15 participants were female, aged >18 years old and with a diagnosis of HS. Mean DLQI score at baseline (day 0) was 19.3, which was reduced to 4.53 on day 21, a significant improvement in 100% of participants (p<0.001). High levels of dressing-related pain, assessed using an 11-point Visual Analogue Scale, reduced from 5.53 at baseline to 0.8 on day 21. Other significant improvements in terms of patient comfort, time spent on changing dressings, body confidence and the dressing's ability to retain exudate were also noted. The results illustrated the improvement made to study participants' day-to-day activities and QoL when effective HS-specific wound care products were provided. Wound care is an essential component in the treatment journey of patients.

Patient perspectives on diagnosis and management of hidradenitis suppurativa: A web-based survey

Patient perspectives on diagnosis and management of hidradenitis suppurativa: A web-based survey

Long-term risk of death in patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is associated with substantial morbidity. Few studies have addressed the natural history and mortality rates associated with HS. A higher risk of cardiovascular death in patients with HS has been reported. We investigated whether patients with HS have an increased overall risk of death compared with age- and gender-matched referents. We performed a retrospective cohort study of residents of Olmsted County, Minnesota, with incident HS between January 1, 1980, and December 31, 2008, and age- and gender-matched referents. The main outcomes and measures were the overall and cause-specific risks of death. We identified 226 incident cases of HS and 678 age- and gender-matched referents among Olmsted County residents during the study period. Compared to referents, patients with HS had a significantly higher risk of all-cause death (hazard ratio [HR, 2.48; 95% CI, 1.53-4.03, P < 0.001) and cardiovascular- or cerebrovascular-related death (HR, 2.85; 95% CI, 1.10-7.40, P = 0.03). However, these risks were attenuated by adjusting for smoking history: all-cause HR, 1.65 (95% CI, 0.97-2.82, P = 0.07) and cardiovascular- or cerebrovascular-related HR, 2.03 (95% CI, 0.71-5.81, P = 0.18). The 71% of patients were former or current smokers at the time of HS diagnosis. Hidradenitis suppurativa patients have a substantially increased risk of death from any cause, including cardiovascular or cerebrovascular causes; the risk is especially dependent on smoking history.

Seasonal Trends of Ambulatory Visit Burden in Hidradenitis Suppurativa Patients

Introduction: Patients with hidradenitis suppurativa (HS) report HS flares with increased heat and sweat. However, there is a paucity of literature on whether there is an increased ambulatory visit burden for HS patients during the warmer months.&#x0D; Methods: We used a nationally-representative database of ambulatory visits in the United States, the National Ambulatory Medical Care Survey to examine the seasonal trends of ambulatory visits for patients with HS. Data analyses were performed using SAS Studio 9.04.01 (SAS Institute, Cary, N.C., USA), and variance in the complex survey design is accounted for by utilizing survey weights to create national estimates and confidence intervals.&#x0D; Results: We identified approximately 2.33 million outpatient visits (95% confidence interval 1.95 million-2.71 million) between 2008-2018 with a diagnosis of HS. Approximately 21% of visits occurred during Winter to early Spring (January to April), 51% during late Spring to Summer (May to August), and 28% during Autumn (September to December). The number of visits differed significantly between these three time periods (X2=13.1, p=0.0014).&#x0D; Conclusion: Awareness of the increased burden of HS during summer months may help guide management, including anticipatory counseling on strategic lifestyle modifications and initiation of anti-hyperhidrosis treatments.

33892 Telehealth use at a specialty hidradenitis suppurativa clinic during the COVID-19 pandemic

COVID-19 has increased the patient burden on medical centers, resulting in a greater reliance on the use of telehealth. As there are few hidradenitis suppurativa (HS) specialty clinics in the U.S. (33 as of 2021), the need for telehealth is even greater in the HS patient population. This study analyzed trends in telehealth usage at a specialty HS clinic during the COVID-19 pandemic. Patients with a diagnosis of HS seen by 2 providers who manage predominantly HS clinics at Beth Israel Deaconess Medical Center (BIDMC) between May 2020-March 2021 were included. Correlation between the number of total telehealth visits per month and the 7-day average of confirmed cases in Massachusetts at the first or second day of every month was calculated. Limitations include being a single-site study and a small sample size. Of 541 visits between May 2020-March 2021, 354 (65.4%) were in-person visits and 187 (34.6%) were telehealth. There was a weak negative correlation between the number of telehealth visits and the number of COVID-19 cases in Massachusetts, (Pearson’s correlation coefficient r = -0.214, P = .528) which suggests a minimal relationship between the prevalence of COVID-19 and the use of telehealth. While COVID-19 may have been the impetus for the increase in telehealth use, patients and physicians continue to conduct a high number of telehealth visits despite COVID numbers. This is likely due to the decreased travel burden and the ability to address flares more urgently.

33288 Hidradenitis suppurativa and dermatologic comorbidities in adults: A national-cross sectional study

Hidradenitis suppurativa (HS) is a rare chronic, inflammatory condition characterized by the development of painful sinus tracts and is associated with numerous comorbidities. Several studies demonstrate an association of HS with pyoderma gangrenosum and acne conglobata, but there has been no broad-spectrum investigation into the dermatologic comorbidities associated with HS using nationally representative data. We analyzed the 2016-2018 National Inpatient Sample, a cross-sectional sample of 20% of all U.S. hospitalizations, for adult patients with and without HS. Compared with the general inpatient population, associations of HS with 25 dermatologic conditions were determined using multivariable logistic regression, adjusting for age, race, sex, and insurance type. Overall, 90,879,561 total hospitalizations were identified, with 62,785 having a diagnosis of HS. As seen previously, HS was more likely to affect females and Black patients. The prevalence of having any of the 25 dermatologic conditions was higher in patients with HS (24.60%, 95% confidence interval [CI]: 23.82%-25.42%) than without (5.30%, 95% CI: 5.26%-5.33%). In multivariable logistic regression models controlling for age, sex, race, and insurance type, HS was associated with having any dermatologic condition (adjusted odds ratio 7.17, 95% CI: 6.86-7.50). Specifically, HS was associated with 18 of the 25 dermatologic conditions. Our research highlights the association between HS and several dermatologic conditions not previously reported. While this study validates the complexity of the HS disease process, more research into HS pathology and etiology is strongly warranted.

Coexistence of pachyonychia congenita and hidradenitis suppurativa: more than a coincidence.

The coexistence of pachyonychia congenita (PC) and hidradenitis suppurativa (HS) has been described in case reports. However, the pathomechanism underlying this association and its true prevalence are unknown. To determine the genetic defect underlying the coexistence of PC and HS in a large kindred, to delineate a pathophysiological signalling defect jointly leading to both phenotypes, and to estimate the prevalence of HS in PC. We used direct sequencing and a NOTCH luciferase reporter assay to characterize the pathophysiological basis of the familial coexistence of HS and PC. A questionnaire was distributed to patients with PC registered with the International Pachyonychia Congenita Research Registry (IPCRR) to assess the prevalence of HS among patients with PC. Direct sequencing of DNA samples obtained from family members displaying both PC and HS demonstrated a missense variant (c.275A>G) in KRT17, encoding keratin 17. Abnormal NOTCH signalling has been suggested to contribute to HS pathogenesis. Accordingly, the KRT17 c.275A>G variant resulted in a significant decrease in NOTCH activity. To ascertain the clinical importance of the association of HS with PC, we distributed a questionnaire to all patients with PC registered with the IPCRR. Seventy-two of 278 responders reported HS-associated clinical features (25·9%). Disease-causing mutations in KRT17 were most prevalent among patients with a dual phenotype of PC and HS (43%). The coexistence of HS and KRT17-associated PC is more common than previously thought. Impaired NOTCH signalling as a result of KRT17 mutations may predispose patients with PC to HS. What is already known about this topic? The coexistence of pachyonychia congenita (PC) and hidradenitis suppurativa (HS) has been described in case reports. However, the pathomechanism underlying this association and its true prevalence are unknown. What does this study add? A dual phenotype consisting of PC and HS was found to be associated with a pathogenic variant in KRT17. This variant was found to affect NOTCH signalling, which has been previously implicated in HS pathogenesis. HS was found to be associated with PC in a large cohort of patients with PC, especially in patients carrying KRT17 variants, suggesting that KRT17 variants causing PC may also predispose to HS. What is the translational message? These findings suggest that patients with PC have a higher prevalence of HS than previously thought, and hence physicians should have a higher level of suspicion of HS diagnosis in patients with PC.

Neighborhood-based analysis of adolescent hidradenitis suppurativa prevalence in a large metropolitan area

Neighborhood-based analysis of adolescent hidradenitis suppurativa prevalence in a large metropolitan area

Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.

729 Upregulation of caveolin-1 in lesional biopsies of hidradenitis suppurativa: A case series report

Hidradenitis suppurativa (HS) is an overlooked and often misdiagnosed inflammatory skin condition characterized by painful recurrent nodules and abscesses that rupture, leading to development of sinus tracts. Because of the associated pain, sensitive locations, drainage, odor and scarring, this condition has a tremendously negative psychosocial impact. Considering that 1) early stages of HS are often mistaken for other conditions, 2) pathophysiology is relatively unknown and 3) there are no established biomarkers of disease, it is unsurprising that an average delay in the correct diagnosis of HS is between 7-12 years.

237 Hidradenitis suppurativa interferes with socialization in the majority of patients regardless of objective disease severity: A cross-sectional survey study

Background: Hidradenitis suppurativa (HS) can severely impact quality of life. However, its specific impact on participation in social activities is not well studied. Objective: To assess HS’s interference with social activities in relation to disease severity. Methods: We recruited patients with a clinical diagnosis of HS (ICD-10 code L73.2) from clinic (n=30) and mail (n=123) to complete a survey. Respondents reported the extent to which HS interfered with social activities (none, a little, a lot).

The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa - A Single Center Analysis of Different Treatment Options.

BackgroundHidradenitis suppurativa is manifested by painful abscesses and scarring of sweat glands. Axillary, inguinal and genital regions are mostly affected. Multiple options exist in the treatment of hidradenitis suppurativa. The aim of this retrospective, mono-center cohort study was to analyze the outcome of different treatment methods after radical excision of hidradenitis suppurativa.MethodsWe retrospectively evaluated the treatment strategy and recurrence rate of hidradenitis suppurativa. We included all eligible patients of legal age between February 2003 and October 2021, with the diagnosis of Hidradenitis suppurativa and the necessity for surgical treatment. All patients with surgical treatment and direct wound closure by suture were excluded. Bacterial load and flora were analyzed for primary and secondary reconstruction in combination with negative-pressure wound therapy. Patient data were analyzed for recurrence rate and remission time according to different reconstructive techniques.ResultsIn 44 affected anatomical sites (n = 23 patients) we treated 15 patients with negative-pressure wound therapy. Bacterial load and flora were lower in the last wound swab of patients with multi-surgical procedures (22 localizations) compared to the first wound swab independent of the use of negative-pressure wound therapy.Wound closure, independent of a direct and multi-stage procedure was achieved by local fasciocutaneous flaps (n = 12), secondary intention healing (n = 7), secondary intention healing with buried chip skin grafts (n = 10), or split-thickness skin grafts (n = 15). Radical excision combined with split-thickness skin grafts showed the lowest recurrence rate in the follow-up (16%; n = 4).ConclusionRadical excision of hidradenitis suppurativa as gold standard for surgical treatment combined with negative-pressure wound therapy as multi-stage procedures ultimately reduced bacterial load and flora in our study. The use of split-thickness skin grafts showed the lowest recurrence rate.

Holistic health record for Hidradenitis suppurativa patients

Hidradenitis suppurativa (HS) is a recurrent inflammatory skin disease with a complex etiopathogenesis whose treatment poses a challenge in the clinical practice. Here, we present a novel integrated pipeline produced by the European consortium BATMAN (Biomolecular Analysis for Tailored Medicine in Acne iNversa) aimed at investigating the molecular pathways involved in HS by developing new diagnosis algorithms and building cellular models to pave the way for personalized treatments. The objectives of our european Consortium are the following: (1) identify genetic variants and alterations in biological pathways associated with HS susceptibility, severity and response to treatment; (2) design in vitro two-dimensional epithelial cell and tri-dimensional skin models to unravel the HS molecular mechanisms; and (3) produce holistic health records HHR to complement medical observations by developing a smartphone application to monitor patients remotely. Dermatologists, geneticists, immunologists, molecular cell biologists, and computer science experts constitute the BATMAN consortium. Using a highly integrated approach, the BATMAN international team will identify novel biomarkers for HS diagnosis and generate new biological and technological tools to be used by the clinical community to assess HS severity, choose the most suitable therapy and follow the outcome.

P152. A RETROSPECTIVE REVIEW OF LASER THERAPY FOR TREATMENT OF HIDRADENITIS SUPPURATIVA

PURPOSE: Hidradenitis Suppurativa (HS) is a chronic inflammatory disease characterized by painful and foul-smelling cystic nodules and sinus tracts in apocrine gland-bearing regions. The treatment ranges from topical, intralesional, systemic, and surgical modalities. Currently, the most novel therapy is the use of laser therapy to create a localized treatment without systemic side effects. However, there is limited data about patient outcomes of the laser treatment due to the low prevalence of the disease. The aim of this paper is to evaluate the efficacy of laser therapy as a treatment modality for patients with HS. METHODS: A retrospective review cohort analysis of HS patients undergoing laser treatment from 2016-2021 was conducted. Patient demographics, location of lesions, Hurley stage, age of onset and diagnosis, treatment length, type, outcomes, and complications were analyzed. RESULTS: Eighty-six patients met the inclusion criteria: On average, patients were treated with 5.6 laser sessions for 17 months without any complications and minor blood loss. HS progression commonly started during puberty, with a median onset of 13.8 years and diagnosis of HS at 16.3 years. All of the patients (n=86) showed an improvement of HS disease severity: 52% completed treatment, 16% currently ongoing treatment, and 31% were lost to follow up. CONCLUSION: Laser therapy is an effective and safe therapy for HS leading to improved quality of life and could be considered in the treatment algorithm for disease management.

Role of magnetic resonance imaging in the pre‐surgical planning of perianal hidradenitis suppurativa, complicated by anal fistulae: A case report and review of the literature

Hidradenitis Suppurativa (HS) is a chronic inflammatory disease of the skin starting from the apocrine glands and mainly involving the axilla, perineum and perianal area. It is clinically defined by the onset of painful subcutaneous nodularities, associated with signs of local inflammation, whose progression proceeds towards the definition of true subcutaneous abscess collections from which fistulous pathways branch off. These lesions result in severe fibro-cicatricial deformities. The diagnosis of HS, which is basically clinical, is followed, due to the recurrent/relapsed nature of the disease, by a difficult therapeutic management, which makes use of different treatments depending on the severity of the pathological picture, ranging from topical or systemic medical therapy to surgical excision. Imaging examinations, although not specific enough in the diagnosis of HS, are essential to define the loco-regional extension of the disease and to exclude possible alternative diagnoses. In particular, MRI plays a key role in the study of HS with anogenital localization, both for the recognition of lesions in the active phase and for the assessment of the local extension of the disease, in particular in adequately demonstrating the entire course of the fistulas and the relationships with the neighboring anatomical structures. This allows the optimization of its treatment, in order to reduce disease recurrence. The case presented by us describes the MRI characteristics in a rare case of HS, complicated by anal fistulae.

Pediatric hidradenitis suppurativa

AbstractPediatric hidradenitis suppurativa (HS) is a chronic inflammatory disorder that often occurs after puberty and can have a significant impact on quality of life and psychosocial health. Early diagnosis with carefully optimized holistic care are essential for improved outcomes in pediatric HS. In this review, we address diagnosis, epidemiology, associated comorbidities, and management of HS in the pediatric population.