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

Kokolakis, Georgios; Wolk, Kerstin; Schneider‐Burrus, Sylke; Kalus, Stefanie; Barbus, Sebastian; Gomis-Kleindienst, Susana; Sabat, Robert

doi:10.2139/ssrn.3416695

Cited by 26 publications

(66 citation statements)

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“…This study found that HS screenpositives had a significantly higher HR of filling prescriptions on antidepressant medication (HR 1.73), pain medication (HR 1.24) and NSAIDs (HR 1.20). As the study population was not sampled from a dermatological department/specialized care unit, they include undiagnosed cases with, probably, a milder phenotype (15). The likelihood of inclusion of people with a milder phenotype in this study is further increased by the fact the study population comprises blood donors.…”

Section: Discussionmentioning

confidence: 99%

“…Surprisingly, in the US study, 82.1% of analgesics prescribed were for opioids (30), but only 16.2% (2,166/13,394) of analgesic prescriptions in the current study were for opiods. This discrepancy can be partly explained by 3 factors: Danish physicians follow the analgesic algorithm created by the WHO (31), which has the use of opioids as the last step; US patients with HS have been shown to have an increased risk of substance abuse (odds ratio 1.5), with opioids ranking second amongst substances abused (32); and, as the US study was a hospital-based registry study, the patients probably had a more severe HS phenotype (15) and thus were more likely to need opioids. Interestingly, a study investigating the type of pain experienced by patients with HS showed that they most often experience both nociceptive and neuropathic pain (33).…”

Section: Discussionmentioning

confidence: 99%

“…However, only 15.1% of the HS screen-positives had also been diagnosed with HS. As the majority of screen-positives therefore have a milder HS phenotype than seen in the clinic (15), this indicates that these comorbidities develop either primarily in those with more severe disease or later in the disease course. This theory is supported by recent findings that demonstrate that, temporally, hypercholesterolaemia is diagnosed after a patient has been diagnosed with HS, whereas diabetes often precedes the HS diagnosis by as little as 6 months (35).…”

Section: Discussionmentioning

confidence: 99%

“…The mean worldwide diagnostic delay of HS is 7.2-10.2 years (12,13), and studies indicate that up to 90% of people with HS symptoms remain undiagnosed (2,14). Consequently, diagnosed cases are those with the most severe disease (15), as HS progresses during the long period of diagnostic delay, and knowledge of HS-related comorbidities therefore originates from cross-sectional studies of patients with severe and long-term disease. Currently, very little is known about the development of HS-related comorbidities during the long diagnostic delay between disease manifestation and diagnosis.…”

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confidence: 99%

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

Andersen¹,

Loft²,

Burgdorf

et al. 2021

Acta Derm Venereol

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Hidradenitis suppurativa is a common recurrent inflammatory skin disease, which is underdiagnosed by physicians. Severe disease is associated with multiple comorbidities, but mild disease with fewer symptoms has been poorly investigated. This study of otherwise healthy blood donors with self-reported hidradenitis suppurativa symptoms and their registry data on drug prescription, found that people with symptoms of mild hidradenitis suppurativa had 1.73 times the risk of depression and 1.24 times the risk of need ing pain medication compared with healthy controls. As people with even mild hidradenitis suppurativa are at risk of pain and depression, clinical practice should increase its focus on diagnosis of this disease. 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Andersen¹,

Loft²,

Burgdorf

et al. 2021

Acta Derm Venereol

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“…In fact, the frequency of patients with potentially misdiagnosed HS (Groups 5/6) was 8.09% (Table 1). Furthermore, an enormous delay in HS diagnosis (about 10 years) has been documented in Germany recently 5 . The assumed large number of undiagnosed HS is alarming.…”

Section: Group 1 Group 2 Group 3 Group 4 Group 5 Groupmentioning

confidence: 99%

Hidradenitis suppurativa – prevalence analyses of German statutory health insurance data

Schneider‐Burrus

Lux

Linde

et al. 2020

Acad Dermatol Venereol

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The measurement performance of the EQ-5D-5L versus EQ-5D-3L in patients with hidradenitis suppurativa

et al. 2021

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Purpose Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects up to 1% of the population in Europe. The EQ-5D is the most commonly used generic instrument for measuring health-related quality of life among HS patients. This study aims to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with HS. Methods We recruited 200 consecutive patients with HS (mean age 37 years, 38% severe or very severe HS) to participate in a multicentre cross-sectional survey. Patients completed the EQ-5D-3L, EQ-5D-5L, Dermatology Life Quality Index (DLQI) and Skindex-16 questionnaires. Results More than twice as many different health state profiles occurred in the EQ-5D-5L compared to the EQ-5D-3L (101 vs. 43). A significant reduction in ceiling effect was found for the mobility, self-care and usual activities dimensions. A good agreement was established between the EQ-5D-3L and EQ-5D-5L with an intraclass correlation coefficient of 0.872 (95% CI 0.830–0.903; p < 0.001) that was confirmed by a Bland-Altman plot. EQ-5D-5L improved both the absolute and relative informativity in all dimensions except for anxiety/depression. EQ-5D-3L and EQ-5D-5L demonstrated similar convergent validity with DLQI and Skindex-16. EQ-5D-5L was able to better discriminate between known groups of patients based on the number of comorbidities and disease severity (HS-Physician's Global Assessment). Conclusion In patients with HS, the EQ-5D-5L outperformed the EQ-5D-3L in feasibility, ceiling effects, informativity and known-groups validity for many important clinical characteristics. We recommend using the EQ-5D-5L in HS patients across various settings, including clinical care, research and economic evaluations.

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

Cited by 26 publications

References 0 publications

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

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

Hidradenitis suppurativa – prevalence analyses of German statutory health insurance data

The measurement performance of the EQ-5D-5L versus EQ-5D-3L in patients with hidradenitis suppurativa

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