602840 research-article2015
CMSXXX10.1177/1203475415602840Journal of Cutaneous Medicine and SurgeryKim et al
Basic/Clinical Science
Clinical Features and Patient Outcomes of Hidradenitis Suppurativa: A Cross-Sectional Retrospective Study
Journal of Cutaneous Medicine and Surgery 1–6 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1203475415602840 jcms.sagepub.com
Whan B. Kim1, R. Gary Sibbald2,3,4,5, Howard Hu4, Morteza Bashash4, Niloofar Anooshirvani6, Patricia Coutts5, and Afsaneh Alavi2,3
Abstract Background: Despite the high burden of disease associated with hidradenitis suppurativa (HS), epidemiologic data are scarce. Objective: The objective was to review demographic features and clinical findings in 80 HS patients from 2 referral centres in Ontario, Canada, from October 2013 to September 2014, and to assess for factors that are associated with more advanced disease. Methods: Multicentre cross-sectional study. The data on demographic and clinical features were obtained by questionnaires and chart review. Results: Of a total of 80 patients (67.5% females), percentages of patients in Hurley stages I, II, and III were 15.4%, 55.8%, and 28.9%, respectively. Most patients were not diagnosed for more than 1 year (70.1%). Patients with more severe disease were more likely to be females and to have a greater number of lesions and were less likely to be diagnosed initially by a dermatologist. Conclusions: This study documents the common demographic and clinical features of HS to optimize resource allocation and patient outcomes. Résumé Contexte : Malgré le lourd fardeau morbide associé à l’hidrosadénite suppurée (HS), les données épidémiologiques sont rares. Objectif : Nous décrivons les caractéristiques démographiques et les observations cliniques chez 80 patients atteints d’HS de 2 centres de référence en Ontario, au Canada, d’octobre 2013 à septembre 2014. Nous avons aussi évalué les facteurs associés aux stades plus avancés de la maladie. Méthodes : Étude transversale multicentrique. Les données sur les caractéristiques démographiques et cliniques ont été obtenues par questionnaire et par examen des dossiers médicaux. Résultats : Les 80 patients (dont 67,5 % sont des femmes) présentent des lésions des stades I, II et III de Hurley (15,4 %, 55,8 % et 28,9 %, respectivement). Pour la plupart des patients (70,1 %), il a fallu plus d’un an avant de recevoir un diagnostic. Les patients atteints d’une forme plus grave de la maladie étaient plus susceptibles d’être des femmes et de présenter un plus grand nombre de lésions, et moins susceptibles d’être initialement diagnostiqués par un dermatologue. Conclusions : Cette étude documente les caractéristiques démographiques et cliniques courantes de l’HS afin d’optimiser la distribution des ressources et les résultats pour les patients. Keywords hidradenitis suppurativa, acne inversa, epidemiology, demographic, Canada
Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition with an estimated prevalence of 1% to 4% in Western countries.1,2 HS is an underdiagnosed skin condition that is disabling and disfiguring, typically affecting adults during the prime of life. The
most common time of onset is around puberty to the early 20s.3 This condition is associated with female gender, obesity, smoking, and a positive HS family history.4 Due to its chronic and recurrent nature, HS is difficult to manage.
2 HS has an extensive physical, emotional, and psychosocial impact on patients, with a large negative effect on the quality of life. The burden of disease includes persistent pain, unpleasant odour, and copious lesional discharge often leading to social embarrassment.5 The significant morbidity associated with HS warrants a need for further research and improved management. However, despite the high burden of the disease, there is a paucity of epidemiologic data. To obtain a more comprehensive evaluation of the epidemiology, we summarized the demographic and clinical features of 80 HS patients in Ontario, Canada, and compared these features with respect to gender and disease severity. This is the largest survey of its kind in a North American population, and only a few previous epidemiological studies have been conducted. The data from this study complement our current knowledge of HS and may serve as a tool for both physicians and policymakers to improve quality of care and patient outcomes.
Methods Study Design and Population After obtaining approval from the institutional review board, we conducted a multicentre, cross-sectional study of patients diagnosed with HS—either evaluated for the first time or assessed during follow-up visits—in 2 Ontario community dermatology clinics from October 2013 to September 2014. These patients were diagnosed with HS by a dermatologist, and after the consent was signed, the survey was completed during a dermatology office visit. Alternatively, charts of previously diagnosed HS patients were reviewed to collect data. These patients were contacted to obtain informed consent before they responded to the questionnaire. All participants were above age 18 and had a confirmed diagnosis of HS by a dermatologist before we obtained demographic features and clinical findings of disease. The data obtained from questionnaires included gender, ethnicity, body mass index, comorbidities, and location of lesions. Information on symptoms and clinical signs documented by their clinicians was also obtained to document Hurley staging (Table 1).
Statistical Analysis Bivariate comparisons of demographic and disease variables in relation to gender and Hurley stage of disease were
Journal of Cutaneous Medicine and Surgery Table 1. Hurley Stagea. Hurley Stage 1
2 3
Description •• •• •• ••
Presence of abscesses No sinus tracts No cicatrization Recurrent abscesses with tract formation and cicatrization •• Diffuse or near diffuse involvement •• Multiple interconnected tracts and abscesses across the entire area
a
Adapted from Hurley.6
performed using chi-square tests. Demographic variables included age, gender, and ethnicity. Disease variables were categorized into comorbidities (smoking, alcohol, depression, obesity, and previous surgery), diagnosis (medical professional who made the initial diagnosis and time to diagnosis), and clinical features (symptom, number of lesions, Hurley stage, and number of episodes per year). For statistical analysis of the above variables with respect to Hurley stage, the less severe Hurley stage I and II patients were combined due to low numbers for comparison with the Hurley stage III patients.
Results Demographic Features During the study period, a total of 80 patients consented to participate in the study and completed the questionnaire. Of these, 67.5% were females, 46.3% were younger than 35 years, and the majority of patients identified themselves as Caucasian (75%) (Table 2). There was a predominance of females with a younger age onset, with more than half under the age of 35.
Comorbidities Slightly less than half of patients (45%) consumed alcohol, while the majority (64.1%) were smokers or former smokers (Table 2). Many individuals had coexisting metabolic disorders including obesity (42.3% had a body mass index >30), diabetes mellitus (25.6%), and hypertension (16.3%) (Table 2). There was a high incidence of obesity, depression, alcohol abuse, and previous surgeries in female patients
1
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada 3 Women’s College Hospital, Toronto, ON, Canada 4 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 5 Wound Healing Clinic, Mississauga, ON, Canada 6 Royal College of Surgeons, Dublin, Ireland 2
Corresponding Author: Afsaneh Alavi, MD, FRCPC, Women’s College Hospital, 76 Grenville Street, 5th floor, Toronto, ON M5S 1B2, Canada. Email:
[email protected]
3
Kim et al Table 2. Demographic and Disease Factors by Gender.
Demographics Comorbidities Diagnosis Clinical features
Age group 5 y Symptom group Inflammatory Noninflammatory No. of lesions ≥5
