Diagnosis Of Hidradenitis Suppurativa Research Articles

Risk of Hidradenitis Suppurativa Comorbidities Over Time: A Prospective Cohort Study of Danish Blood Donors.

Hidradenitis suppurativa is a common recurrent inflammatory skin disease. It is associated with multiple comorbidities whose temporal relationships are unknown due to long diagnostic delays. This study of otherwise healthy blood donors with self-reported symptoms of hidradenitis suppurativa investigated the temporal relationships of comorbidities. A prospective survival analysis on a nationwide cohort of blood donors, using registry data on drug prescription, was used to calculate the hazard ratio of time until first prescription of medical treatment for the following hidradenitis suppurativa-related comorbidities: heart disease, diabetes, depression, thyroid disease and pain. Hidradenitis suppurativa status was determined by a validated questionnaire, and the survival analysis was adjusted for age, sex, body mass index, smoking status and having an International Classification of Diseases Version 10 (ICD-10) diagnosis of hidradenitis suppurativa. Of the participants, 1,012 reported hidradenitis suppurativa symptoms, and these symptoms increased the hazard ratio of antidepressants (1.73, 95% confidence interval 1.17–2.56, p ≈ 0.006) and analgesics (hazard ratio 1.24, 95% confidence interval 1.11–1.39, p < 0.001). Pain and depression are the first comorbidities to present in hidradenitis suppurativa pathogenesis.

Hidradenitis suppurativa and atopic dermatitis: A 2-way association

The coexistence of hidradenitis suppurativa (HS) and atopic dermatitis (AD) had been reported but, to our knowledge, was not investigated in controlled studies. To evaluate the bidirectional association between HS and AD. A population-based retrospective cohort study was conducted to compare the incidence rate of AD among patients with HS (n=6779) and age-, sex-, and ethnicity-matched control individuals (n=33,260). Adjusted hazard ratios (HRs) and adjusted odds ratios were estimated. The incidence of AD was 2.51 (95% confidence interval [CI], 2.07-3.02) and 1.24 (95% CI, 1.10-1.40) per 1000 person-years among patients with HS and control individuals, respectively. Patients with HS were twice as likely to develop AD as control individuals (HR, 2.06; 95% CI, 1.64-2.58). Furthermore, the prevalence of pre-existing AD was higher in patients with HS than in control individuals (2.5% vs 1.8%, respectively; P<.001). A history of AD was associated with a 40% increase in the odds of HS (odds ratio, 1.41; 95% CI, 1.19-1.67). Relative to patients with isolated HS, those with a dual diagnosis of HS and AD were younger and had a female predominance, lower prevalence of smoking, and lower body mass index. Retrospective data collection. A bidirectional association between HS and AD was observed. Dermatologists should be aware of this association.

New insights into hidradenitis suppurativa diagnosis via salivary infrared biosignatures: A pilot study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease which can lead to a prolonged physical disability. HS diagnosis is exclusively clinical with the absence of biomarkers. Our study aims at assessing the HS-diagnostic potential of infrared spectroscopy from saliva, as a biofluid reflecting the body's pathophysiological state. Infrared spectra from 127 patients (57 HS and 70 non-HS) were processed by multivariate methods: principal component analysis coupled with Kruskal-Wallis or Mann-Whitney tests to identify discriminant spectral wavenumbers and linear discriminant analysis to evaluate the performances of HS-diagnostic approach. Infrared features, mainly in the 1300 cm-1 -1600 cm-1 region, were identified as discriminant for HS and prediction models revealed diagnostic performances of about 80%. Tobacco and obesity, two main HS risk factors, do not seem to alter the infrared diagnosis. This pilot study shows the potential of salivary "liquid biopsy" associated to vibrational spectroscopy to develop a personalized medical approach for HS patients' management.

18410 A retrospective analysis of the duration of long-term oral antibiotic use for the treatment of hidradenitis suppurativa

Hidradenitis suppurativa (HS) is an inflammatory skin condition often treated with oral antibiotics. The duration of use in clinical studies is typically 12-16 weeks, however it is possible that longer durations are used in clinical care. This study aimed to investigate the duration of long-term oral antibiotic use for the treatment of HS. The MarketScan database was queried for patients with a diagnosis of HS from January 1 through December 31, 2005. Antibiotic use and duration was determined using National Drug Codes.

14344 The risk of inflammatory arthritis after a diagnosis of hidradenitis suppurativa: A population-based follow-up study

Background: Hidradenitis suppurativa (HS) has been associated with axial spondyloarthritis. This study aims to evaluate and compare the risk of developing different inflammatory arthritis diseases among patients with HS.

17101 A retrospective review of delay in diagnosis and dermatology visits characterized by insurance type in patients with hidradenitis suppurativa in a Midwestern population

Hidradenitis suppurativa (HS) is an inflammatory skin condition that is believed to disproportionately affect populations with low socioeconomic status. We searched the Medical College of Wisconsin and Froedtert Health i2b2 electronic data warehouse, including more than 1.3 million patients in Southeast Wisconsin, for patients with an HS diagnosis and ≥3 encounters for HS using ICD9 705.83 and ICD10 L73.2 codes. We randomly characterized 373 of 1190 identified patients by retrospective chart review, excluding patients without an encounter for HS treatment. Of 243 patients with documentation of insurer at the time of HS diagnosis, 25.5% (62) had private insurance, 20.6% (50) had Medicaid, 12.8% (31) had Medicare, and 41.2% (100) were uninsured. 223 of these patients also had documentation of year of symptom onset and year of HS diagnosis. The mean delay in diagnosis was 2.84 years (n = 89) for uninsured patients, 3.86 years (n = 56) for patients with private insurance, 4.6 years (n = 30) with Medicare, and 6.77 years (n = 48) with Medicaid. Of 243 patients with documentation of insurer at the time of HS diagnosis, 64.5% (40) of patients with private insurance, 60.0% (30) with Medicaid, 46.0% (46) of uninsured patients, and 32.3% (10) with Medicare have seen a dermatologist for treatment of HS. Our findings suggest that insurance class, a determinant of access to care, may impact effective management of HS and should be further explored.

16604 A retrospective review of delay in diagnosis, severity of disease, and dermatology visits characterized by race in patients with hidradenitis suppurativa in a Midwestern population

Hidradenitis suppurativa (HS) is an inflammatory skin condition that disproportionately affects African Americans. We searched the Medical College of Wisconsin and Froedtert Health i2b2 electronic data warehouse, including more than 1.3 million patients in Southeast Wisconsin, for patients with an HS diagnosis and ≥3 encounters for HS using ICD9 705.83 and ICD10 L73.2 codes. We randomly characterized 373 of 1190 identified patients by retrospective chart review, excluding patients without an encounter for HS treatment.

Hidradenitis suppurativa is associated with hypothyroidism and hyperthyroidism: a large-scale population-based study.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the skin bearing apocrine glands. There are numerous comorbidities and associated diseases among patients with HS. The association of HS and thyroid abnormalities is equivocal. We aimed to explore whether HS is associated with thyroid disorders. In this cross-sectional large-scale population-based study in Israel, patients with a validated diagnosis of HS were matched at a proportion of 1:5 with age- and gender-matched healthy controls without HS. A cross-checking for HS diagnosis by International Classification of Diseases, ninth revision (ICD-9) coding, and hyperthyroidism and hypothyroidism by ICD-9 coding was performed. Demographic and exposure covariates were identified. Univariate and multivariate logistic regressions were utilized to establish the association of HS with thyroid disorders. Study participants included 4,191 HS patients and 20,941 controls. The average age of patients was 39.7years old, and 61.8% were female. 53.4% of HS patients and 13.5% of controls (P<0.001) were smokers. Odds ratios (ORs) for hypothyroidism and hyperthyroidism in HS were 2.91 (95% confidence interval [CI] 2.48-3.40) and 2.25 (95% CI 1.55-3.28), respectively (P<0.001 for both). While the association of HS with hypothyroidism was maintained across genders and all age groups, and remained positive after controlling for smoking status, the association with hyperthyroidism remained positive only among females, middle-aged patients, and nonsmokers. HS is independently associated with hypothyroidism. The association of HS with hyperthyroidism held significance only in limited subgroups. Smoking status is a major modifier, mainly in the association of HS with hyperthyroidism.

Analysis of hidradenitis suppurativa hospitalizations: A report from the National Inpatient Sample database

Analysis of hidradenitis suppurativa hospitalizations: A report from the National Inpatient Sample database

Development and Validation of HSCAPS-1: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess

Background: A clinical decision support tool may improve recognition of hidradenitis suppurativa (HS) and reduce diagnosis delay. Objective: To develop and initially validate a clinical decision support to predict diagnosis of HS and distinguish it from cutaneous abscess of the axilla, groin, perineum, and buttock. Methods: This was a retrospective, cross-sectional analysis between January 2012 and June 2017 (development set) and July 2017 and March 2019 (validation set). We used an electronic records sample of 56 million patients from the Explorys database to identify patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock. The outcome was predicted probability of HS diagnosis. Results: Development set included 7,974 patients with mean age of 41.4 years, who were predominantly female (66%) and white (62%). Validation set included 1,560 patients with similar demographic composition. Factors which were stronger independent predictors of HS included female sex (OR 2.17 [95% CI 1.96–2.40]); African American race (1.28 [95% CI 1.15–1.44]); increasing BMI (OR 1.05 [95% CI 1.05–1.06)]; history of acne (OR 3.46 [95% CI 2.83–4.23]); Down syndrome (OR 5.35 [95% CI 2.03–14.12]); and prescription for at least 7 opioid medications in the past year (OR 1.05 [95% CI 0.83–1.33]). Up to age 45 years, increasing age was a stronger predictor of HS diagnosis. The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept –0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076]). Conclusion: This clinical decision support tool shows good performance in predicting diagnosis of HS and distinguishing it from cutaneous abscess that involves the axilla, groin, perineum, and buttock.

Sub-classification of Hidradenitis suppurativa: a cross-sectional study

The typical Hidradenitis Suppurativa (HS) patient is a young woman with axillary and groin involvement, but the spectrum of the disease presentation is broad and no internationally acknowledged sub-classification of the disease exists to date. It is however speculated that different, yet unidentified, subtypes may respond differently to different treatments or carry a different prognosis. Classification according to self-reported clinically meaningful outcomes for patients offer practical advantages. Our objective was to build an empirical framework for sub-classification of HS patients based on the frequency of HS flares in various anatomic locations, using a cross-sectional questionnaire-based design. All patients with a clinically confirmed diagnosis of HS registered at our department until March 1, 2017 were invited to participate. The frequency of HS flares in various anatomic locations was used for identification of possible HS subtypes using Principal Component Analysis (PCA) and cluster analysis. A total of 524 (62%) of 845 invited patients answered the questionnaire; 402 (76.7%) were female. From the cluster analysis, we identified two possible subtypes of HS, labeled the "upper type" and the "lower type". The "upper type" was characterized by repeated outbreaks in axillary and mammary regions. Meanwhile, the "lower type" was characterized by outbreaks in the inguinal, genital, perianal, and gluteal regions. Our findings support the notion that HS can be sub-classified and imply that the pattern of where lesions are located may be an important element in future HS sub-classification systems.

Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that severely impairs patients' quality of life. It is characterized by recurrent painful nodules, abscesses and draining sinus tracts in primarily intertriginous areas. We aimed to review the most up-to-date information regarding the epidemiology, clinical presentation, diagnostic studies, pathogenesis, comorbidities and quality of life of patients with hidradenitis suppurativa. We performed a systematic search of Medline, Embase database (from inception to September 2019) and review of bibliographies without restrictions on year or language. HS has an estimated global prevalence of 0.00033-4.1% (but most likely 0.7-1.2% in the European-US population). Patients still experience a significant diagnostic delay, up to several years. In the absence of pathognomonic tests, the diagnosis of HS is made from clinical observation and the disease narrative. Phenotypic variation renders diagnosis and severity assessment difficult. Ultrasound imaging is an emerging assessment tool for deep-seated lesions. The Hurley Staging System is still widely used in severity rating. Follicular hyperkeratosis and dilatation, follicular rupture and chronic inflammation with architectural tissue changes have been implicated in the pathogenesis of HS. HS has been associated with metabolic syndrome and other risk factors for cardiovascular disease, diabetes mellitus type II, polycystic ovarian syndrome, depression, suicide and substance use disorders. It has been linked to other immune-mediated diseases such as inflammatory bowel disease and spondyloarthropathy. Pain, pruritus, malodour, low self-esteem, sleep and sexual dysfunctions, and poor mental health are chronic symptoms or consequences of uncontrolled disease. HS is an under-diagnosed and under-treated disease with a profound negative impact on patients' quality of life. In the light of its associated comorbidities, an interdisciplinary management approach may be needed to ensure the best outcomes.

Hidradenitis suppurativa is associated with acne keloidalis nuchae: a population-based study.

The association between acne keloidalis nuchae (AKN) and hidradenitis suppurativa (HS) is yet to be investigated. To determine the link between AKN and HS using a large computerized health maintenance database. A cross-sectional study design was used to assess the prevalence of HS in patients with AKN and in control participants matched by age, sex, and ethnicity. A total of 2677 participants with AKN and 13,190 control participants were studied. An increased prevalence of HS was observed in the AKN group compared to the control group (1.0% vs. 0.3%, respectively; OR, 3.6; 95% CI 2.2-5.8; P < 0.001), especially among those younger than 20years (OR, 10.2; 95% CI 3.1-34.2; P < 0.001), and females (OR, 15.7; 95% CI 3.1-78.8; P < 0.001). After adjusting for confounding factors, the multivariate analysis demonstrated a persistent association of AKN with HS (adjusted OR, 3.6; 95% CI 2.1-5.9; P < 0.001). This study demonstrated a significant association between AKN and HS in an Israeli population. The threshold for diagnosis of HS among patients with AKN must be lowered in patients presenting with concerning symptoms. Further observational studies in other patient populations will help confirm this relationship.

Delayed Diagnosis of Hidradenitis Suppurativa and Its Effect on Patients and Healthcare System

Background: Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients experience metabolic, musculoskeletal, and psychological disorders. Objectives: To determine the delay in HS diagnosis and its consequences for patients and the healthcare system. Methods: This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated. Results: The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians – most frequently general practitioners, dermatologists, surgeons, gynecologists – and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed. Conclusion: This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.

ROMATOLOJİK HASTALIKLARDA HİDRADENİTİS SÜPÜRATİVA’NIN ÖNEMİ

Objective: Hidradenitis suppurativa (HS) is a recurrent chronic inflammatory disease of the apocrine glands. It is more common in women, especially after puberty. The primary locations affected are the axillary, inguinal, perianal, and perineal regions, with a painful nodüle and a complex of symptoms ranging from abscesses to sinus formation and hypertrophic scars. Obesity and metabolic syndrome, especially spondyloarthritis, autoinflammatory diseases and some autoimmune diseases are more common in HS patients. In this study, we aimed to determine the etiologic factors, demographic and clinical characteristics of patients with HS who were attending our rheumatology clinic. Material and Methods: This study was performed retrospectively in the Department of Rheumatology between January 2017 and December 2018. Eleven patients diagnosed with HS and over 18 years of age were included in the study. Epidemiological, clinical, and laboratory findings, along with treatment information file records of patients, were obtained through examinations. Results: Of 11 patients diagnosed with HS, 10 were male and one was female. The mean age of the patients was 40.9 years (minumum 22, maximum 57). When evaluated for concomitant rheumatologic diseases, four cases of spondyloarthritis, three of Behcet’s disease, one of Familial Mediterranean Fever, one of rheumatoid arthritis, one of gout and one of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) were diagnosed. Conclusion: HS may be associated with rheumatic diseases. Therefore, a differential diagnosis should be made in patients followed up with the diagnosis of HS in the case of rheumatologic complaints.&nbsp;&nbsp;

430 Crohn's disease prevalence prior to and following hidradenitis suppurativa diagnosis

Previous studies have shown differing results on the prevalence of Crohn’s disease in HS [1,2]. Our study used a large claims database to determine the prevalence of Crohn’s disease in HS. The Arcadia.io database includes insurance claims and visit-level data from > 34,000,000 discrete lives. The database was searched for individuals with a diagnosis of Crohn's disease within the general patient cohort. Patients with >1 coded diagnosis of HS (ICD-9:705.83 or ICD-10:L73.2) in a clinical setting at any time were identified. Within the HS group, patients with Crohn's disease were identified at time of HS diagnosis and up to 3 years after initial HS diagnosis. Prevalence was determined by rate of diagnosed individuals out of all individuals stored at the time of the search; all identities were de-duplicated. Prevalence was further stratified by reported sex and age. The prevalence of Crohn’s disease in the entire adult cohort was 0.5% (N=36,546, general cohort population= 7.8 million) which appeared to be consistent across different age groups and sex categories. The prevalence of Crohn’s disease prior to or at time of HS diagnosis was 0.85% (HS cohort= 38,841) and had an even further increase at 1.4% (HS cohort= 39,897) prevalence following HS diagnosis. Crohn’s disease appears to have increased prevalence in HS compared to the overall cohort and even greater prevalence following HS diagnosis. Further studies may provide information in regards to disease detection.

265 Genome-wide association study of hidradenitis suppurativa in a multi-ethnic cohort

Hidradenitis suppurativa (HS) is a prevalent inflammatory skin disease. HS patients suffer from deep, painful, recurrent abscesses that drain malodorous fluid and lead to disfiguring scars that can limit mobility. African Americans and females are at an increased risk. A lack of effective therapies and limited knowledge about HS pathogenesis contribute to unmet needs. Unlike other common inflammatory skin diseases, there has never been a genome-wide association study (GWAS) conducted for HS. Here, we performed a first GWAS for HS using data from the eMERGE network of electronic health record linked biorepositories (project NT227). We used HS diagnosis codes to identify cases and controls. We estimated ancestry with principal component analysis using a set of 40,156 SNPs. Our final cohort consisted of 600 HS cases and 82,611 controls with comparable multi-ethnic ancestry (λ=1.005). Our cohort recapitulated HS race and gender predilictions with genetically African female participants accounting for 35% of cases, but only 10% of controls. Genotype data for 40 million variants was tested for association, adjusting for five principle components. No locus exceeded our threshold for statistical significance. There was no evidence for HLA association supporting classification of HS as inflammatory rather than autoimmune. Several loci approached the significance threshold, suggesting that a moderate expansion in cohort size may provide adequate power to detect associations. Interestingly, the lead SNP at one of the most significant loci (rs11075745; p=8x10-7) is an eQTL for NFAT5, a mediator of NOTCH signaling whose expression is downregulated in HS lesional skin relative to patient-matched nonlesional skin. The risk allele influences expression in tissue specific manner. Our group is constructing multi-ethnic replication cohorts that will allow us to expand this study in the near future.

Proposed Definitions of Typical Lesions in Hidradenitis Suppurativa

Background: Although not rare, hidradenitis suppurativa (HS) is often under-recognized by physicians. The diagnosis of HS is clinical via the recognition of lesions typical of the disease, but universally accepted definitions of these latter are currently lacking, which means that certain severity scores employed for HS classification/management are used differently by different physicians. Our aim was to develop a set of descriptive definitions and associated images of HS lesions, in order to enable doctors to better recognize and evaluate the disease. Methods: MEDLINE-available literature and dermatological textbooks on HS morphology were retrieved (January 1996 to February 2016). A preliminary set of definitions of HS typical lesions was created, including 10 terms. Each term was associated with a pathophysiological classification and an image. This preliminary set was shown during the 5th Conference of the European HS Foundation (EHSF). The physicians attending the event were invited to vote on each term and make comments via a voting sheet. Results: A total of 81 physicians answered the questionnaire. Their agreement/disagreement rates and comments were used to obtain a revised set of definitions and images. Pathophysiological classifications were dropped. Conclusion: A user-friendly set of definitions/images of HS typical lesions was proposed and will need to be validated by further studies. This set could ultimately serve as a tool to better recognize, score, and assess treatment efficacy.

4429 Powering precision medicine research with the efficient construction of large diverse cohorts

OBJECTIVES/GOALS: There is an imperative need to initiate translational genetic studies of hidradenitis suppurativa (HS). Such work requires large cohorts and no HS registries exist. Precision medicine initiatives provide new resources and methods for efficiently constructing cohorts, but empirically informed best practice guidelines are needed. METHODS/STUDY POPULATION: Traditional methods for building cohorts rely on clinical encounters to identify patients and collect phenotype data. Precision medicine initiatives aim to decrease the time and cost of data collection by using alternative sources, including electronic health records (EHR) and remote collection of patient-reported data. The public’s use of the Internet to obtain and exchange health-related information coupled with the success of direct-to-consumer genetic companies suggests that it is feasible to remotely ascertain research participants for genetic studies. Importantly, Internet cohorts provide an opportunity to include research participants who are disconnected from healthcare, and thus remain hidden from research that relies on EHR or clinical services. RESULTS/ANTICIPATED RESULTS: First, to conduct studies in EHR we are developing an analytic pipeline for the automated extraction of an accurate HS diagnosis using natural language processing of clinical notes. In our preliminary work we are also using ICD codes to build cohorts in two EHR systems with and without linked genetic data. Second, we have developed Internet advertising campaigns for symptom-based recruitment. Informed consent and patient-reported data is collected on-line through a series of short surveys. Patients who complete the surveys and express interest in participating in genetic studies are sent saliva collection kits and return mailing material. Finally, we have established an HS biobank that has DNA from 300 participants identified through clinical services. Enrollment is on going. DISCUSSION/SIGNIFICANCE OF IMPACT: Our goal is to assemble an HS cohort that is large enough to power genetic discoveries. Our work is generating empirical evidence for precision medicine guidelines and will improve our knowledge about HS. The methods we are developing can be applied to efficiently create new cohorts for genetic studies of other diseases across different clinical areas.

Disease Trajectories for Hidradenitis Suppurativa in the Danish Population

Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent inflamed nodular lesions and is associated with multiple comorbidities; previous studies have been of cross-sectional design, and the temporal association of HS with multiple comorbidities remains undetermined. To evaluate and characterize disease trajectories in patients with HS using population-wide disease registry data. This retrospective registry-based cohort study included the entire Danish population alive between January 1, 1994, and April 10, 2018 (7 191 519 unique individuals). Among these, 14 488 Danish inhabitants were diagnosed with HS or fulfilled diagnostic criteria identified through surgical procedure codes. Citizens of Denmark with a diagnosis code of HS as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) or as identified through surgical procedures. Disease trajectories experienced more frequently by patients with HS than by the overall Danish population. Strength of associations between disease co-occurrences was evaluated using relative risk (RR). All significant disease pairs were tested for directionality using a binomial test, and pairs with directionality were merged into disease trajectories of 3 consecutive diseases. Numerous disease trajectories were combined into a disease progression network showing the most frequent disease paths over time for patients with HS. A total of 11 929 individuals were identified by ICD-10 diagnosis codes (8392 [70.3%] female; mean [SD] age, 37.72 [13.01] years), and 2791 were identified by procedural codes (1686 [60.4%] female; mean [SD] age, 37.38 [15.83]). The set of most common temporal disease trajectories included 25 diagnoses and had a characteristic appearance in which genitourinary, respiratory, or mental and behavioral disorders preceded the diagnosis of HS and chronic obstructive pulmonary disease (604 cases [4.2%]; RR, 1.57; 95% CI, 1.55-1.59; P < .001), pneumonia (827 [5.7%]; RR, 1.18; 95% CI, 1.15-1.20; P < .001), and acute myocardial infarction (293 [2.0%]; RR, 1.37; 95% CI, 1.35-1.39; P < .001) developed after the diagnosis. The findings suggest that patients with newly diagnosed HS may have a high frequency of manifest type 1 diabetes and subsequent high risk of acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease.