Dermatology

Demographics of Hidradenitis Suppurativa

AUTHORS:
Alexandra Grammenos, MS; Leah Cardwell, MD; and Steven R. Feldman, MD, PhD

CITATION:
Grammenos A, Cardwell L, Feldman SR. Demographics of hidradenitis suppurativa. Consultant360. Published online December 21, 2016.

 

Dermatologic issues constitute a great deal of complaints encountered by primary care physicians. Skin disorders are the most common cause for non-acute ambulatory complaints, accounting for nearly 43% of all complaints over a 5-year period.1 These included 19 ICD-9 code diagnoses ranging from actinic keratosis to acne.1 Of these conditions, many have significant psychosocial impact. Accurate diagnosis and effective treatment help prevent morbidity and adverse psychosocial impact. Consideration of patient demographics can aid practitioners in developing differential diagnoses and case-specific treatment plans. Certain demographic groups may be more likely to present with a particular disease; diseases in certain demographic groups may respond better to a particular treatment plan. Demographic categories include, but are not limited to, gender, race, age, and comorbidities. 

Hidradenitis suppurativa (HS) is an inflammatory skin condition. The pathogenesis is not fully understood. HS is thought to result when the hair follicle becomes occluded, ruptures, and leaks keratin and bacteria into the dermis leading to a robust inflammatory response involving the apocrine gland and pilosebaceous unit.2 The condition typically manifests in the axilla, anogenital, and inframammary regions.3 HS is characterized by erythematous, edematous, often indurated nodules that are painful and chronic in nature.  The lesions may rupture, leaking purulent or serosanguinous drainage. Patients often report a foul odor associated with the drainage. Chronicity of disease is marked by formation of sinus tracts and fibrotic bands. HS lesions may serve as a nidus for secondary bacterial infection. 

HS has a female predominance, with a nearly 4:1 ratio of women to men.4 Hormones such as estrogen and progesterone influence the occurrence and extent of HS flares.2 There is a correlation between oral contraceptives and increased incidence of HS.5 The incidence of HS is higher in African American patients compared to Caucasians, Asians, and Hispanics.3,6 Onset of HS is typically between the ages of 20 and 40. Obesity increases the likelihood of HS development, because the increased adipose tissue increases friction and physiological stress on body tissues in common locations of HS involvement. Research suggests that avoidance of dairy and high glycemic load foods may reduce the androgen-mediated follicular duct obstruction, which is characteristic of HS.7 A positive smoking history has been linked with an increased incidence of HS. Nicotine may increase keratinocyte proliferation and obstruction of the hair follicle.2 Of patients diagnosed with HS, nearly 40% have a positive family history of the condition.8 

HS has tremendous psychosocial impact. Through diligent management, the morbidity and psychosocial detriment associated with HS may be reduced.

Alexandra Grammenos, MS, is in the Center for Dermatology Research in the Department of Dermatology at the Wake Forest School of Medicine in Winston-Salem, North Carolina.

Leah Cardwell, MD, is in the Center for Dermatology Research in the Department of Dermatology at the Wake Forest School of Medicine in Winston-Salem, North Carolina.

Steven R. Feldman, MD, PhD, is in the departments of dermatology, pathology, and public health sciences at Wake Forest School of Medicine in Winston-Salem, North Carolina.

Disclosures:

Alexandra Grammenos, MS, has no conflicts of interest to disclose.

Leah Cardwell, MD, has no conflicts of interest to disclose.

Steven R. Feldman, MD, PhD, has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Baxter, Boeringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Taro, Abbvie, Cosmederm, Anacor, Astellas, Janssen, Lilly, Merck, Merz, Novartis, Regeneron, Novan, Parion, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and National Psoriasis Foundation. He also consults for others through Guidepoint Global, Gerson Lehrman, and other consulting organizations. Steve is founder and majority owner of www.DrScore.com and is a founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment.

References:

  1. St. Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013;88(1):56-67. doi:10.1016/j.mayocp.2012.08.020.
  2. von Laffert M, Stadie V, Wohlrab J, Marsch WC. Hidradenitis suppurativa/acne inversa: bilocated epithelial hyperplasia with very different sequelae. Br J Dermatol. 2011;164(2):367-371. doi:10.1111/j.1365-2133.2010.10034.x.
  3. Vlassova N, Kuhn D, Okoye GA. Hidradenitis suppurativa disproportionately affects African Americans: a single-center retrospective analysis. Acta Derm Venereol. 2015;95(8):990-991. doi:10.2340/00015555-2176.
  4. Shah N. Hidradenitis suppurativa: A treatment challenge. Am Fam Physician. 2005;72(8).
  5. Stellon AJ, Wakeling M. Hidradenitis suppurativa associated with use of oral contraceptives. BMJ. 1989;298(6665):28-29. http://www.ncbi.nlm.nih.gov/pubmed/2492847. Accessed December 8, 2016.
  6. McMillan K. Hidradenitis suppurativa: Number of diagnosed patients, demographic characteristics, and treatment patterns in the United States. Am J Epidemiol. 2014;179(12):1477-1483. doi:10.1093/aje/kwu078.
  7. William Danby F. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol. 2015;73(5):S52-S54. doi:10.1016/j.jaad.2015.07.042.
  8. von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389-392. doi:10.1046/j.1468-3083.2000.00087.x.