Original article
Hidradenitis suppurativa: A retrospective study of 846 Dutch patients to identify factors associated with disease severity

https://doi.org/10.1016/j.jaad.2014.04.001Get rights and content

Background

Few comprehensive studies exist on the epidemiology of hidradenitis suppurativa, a very distressing skin disease.

Objective

We sought to identify disease-related factors associated with severity, sex, and family history.

Methods

Ordinal logistic regression was used in 846 consecutive Dutch patients with hidradenitis suppurativa to calculate odds ratios (ORs) for severity according to Hurley. Sex and family history were compared using Student t test and χ2 test.

Results

In total, 45.5% of the patients had Hurley I, 41.5% had Hurley II, and 13.0% had Hurley III. Severity was associated with male sex (OR 2.11; P < .001), disease duration (OR 1.03; P < .001), body mass index (OR 1.03; P = .01), smoking pack-years (OR 1.02; P = .001), and axillary (OR 2.24; P < .001), perianal (OR 1.92; P < .001), and mammary lesions (OR 1.48; P = .03). Women had earlier onset, more inguinal and mammary lesions, and more frequent family history for hidradenitis suppurativa. Men more commonly had gluteal, perianal, and atypical lesions, and a history of severe acne. Patients with a family history had earlier onset, longer disease duration, a history of severe acne, more extensive disease, and were more often smokers.

Limitations

Some parameters were patient-reported.

Conclusion

The severity risk factors identified in this study could help physicians to select patients who need close monitoring and who would benefit from early, aggressive therapy.

Section snippets

Methods

Between 2007 and 2013, we collected the data from all consecutive patients with HS referred to 3 Dutch clinics with a special interest in HS: the Department of Dermatology at Erasmus Medical Center, Rotterdam; the Department of Dermatology at Deventer Hospital, Deventer; and the Department of Plastic Surgery at Diaconessenhuis, Leiden. The respective diagnoses of HS in these hospitals were made by one of the authors or Duco G. van den Broecke, MD, (Department of Plastic Surgery,

Results

A total of 846 patients with HS were seen, 410 at Erasmus Medical Center, 404 at Deventer Hospital, and 32 at Diaconessenhuis, and were included and analyzed (Table I). The mean age was 38.0 ± 12.7 years, with mean disease duration of 13.8 ± 11.0 years. The majority of patients were female (72.6%). Approximately one-third had a normal weight (36.2%), one-third were overweight (31.5%), and another third were obese (32.3%). The overall body mass index (BMI) was 28.1 ± 6.1. A majority was current

Discussion

This analysis of 846 patients with HS in The Netherlands determined 5 severity risk factors: male sex, obesity, smoking pack-years, disease duration, and lesions in the axillary, perianal, and mammary regions.

Our finding of a higher risk of severe disease in males was previously suggested by Matusiak et al15 in 54 patients with HS, and more recently by Vazquez et al16 in 268 patients with HS. The outcome that obesity (measured as BMI) is a severity risk factor was in accordance with the results

References (16)

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Funding sources: None.

Disclosure: Dr Prens received grants from AbbVie (Grant number: PSA 45232, February 6, 2011), and is on the advisory board of AbbVie. Dr Schrader, Deckers, van der Zee, and Boer have no conflicts of interest to declare.

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