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

Abstract

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.

Identifying Unmet Care Needs and Important Treatment Attributes in the Management of Hidradenitis Suppurativa: A Qualitative Interview Study

“…Such disease consequences have a substantial negative impact on general and skin-specific QoL [ 13 , 14 ]. Hidradenitis suppurativa is frequently misdiagnosed with an average duration from manifestation of first symptoms until diagnosis reported of 10.0 ± 9.6 (mean ± standard deviation) years despite the existence of published diagnostic criteria [ 5 , 15 – 17 ]. Because of the multifaceted nature of the disease, its course can be unpredictable, which poses challenges for patients and healthcare professionals (HCPs) in the management of the disease [ 16 ].…”

Utilization of health services for skin disorders during military operations. A population- based study

“… 15 A postponed professional attention, diagnosis and treatment may result in a more severe disease that, in turn may result in extensive destruction of skin architecture, scarring, impaired health status and professional life, and even higher number of concomitant systemic disorders as seen in acne 16 and hidradenitis supporativa. 17 The health practitioners have to be aware of alarming situations of this kind and take necessary measures to prevent possible exacerbations in case of a national crisis. This has become especially evident in the midst of the recent COVID-19 pandemic, when the health systems in most countries had to rapidly adjust to providing routine care to citizens under strenuous conditions of a worldwide crisis.…”

Development of In-Situ Spray for Local Delivery of Antibacterial Drug for Hidradenitis Suppurativa: Investigation of Alternative Formulation

“…Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin that affects around 1% of the general population [ 2 ] and it has an estimated prevalence of 1 to 4% [ 3 ]. It has been noticed that lack of awareness led to this disease being misdiagnosed often, especially in the early stages, or diagnosed late, with an average of 7 years [ 3 , 4 ]. HS can present in many people, where an appropriate early recognition and diagnosis are important to help patients understand the situation and ensure prompt disease management [ 5 , 6 ] to avoid an increase in the development of patients’ secondary psychiatric disorders, for instance, anxiety and depression, that could eventually lead to a higher risk of suicide [ 2 ].…”

“…The progression of the disease is rapid during the period of misdiagnosis or late recognition, where the disease leads to minor inflammations until the destruction of the skin tissues. The only treatment for such conditions is to undergo surgical removal of the skin on the infected site [ 4 ]. Surprisingly, a recent report revealed that the unemployment rate of the patients diagnosed with HS is 25.1% as compared to the control population at 5.9% [ 4 ].…”

“…The only treatment for such conditions is to undergo surgical removal of the skin on the infected site [ 4 ]. Surprisingly, a recent report revealed that the unemployment rate of the patients diagnosed with HS is 25.1% as compared to the control population at 5.9% [ 4 ].…”