Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, recurring, inflammatory disorder of the hair follicles in intertriginous and anogenital regions of the body.1,2 Characteristic lesions of HS include painful inflammatory nodules, subcutaneous abscesses, comedones, tunneling sinus tracts, and hypertrophic scarring.1,2

The chronic and recurring nature of HS and long-term sequelae (eg, skin contractures, chronic pain, and disfigurement) may have a profound negative impact on quality of life and have established HS as one of the most debilitating dermatologic conditions.1,3

Prevalence and Etiology of Hidradenitis Suppurativa

Hidradenitis suppurativa affects approximately 1% to 2% of the US population and is more commonly seen in women, Black patients, and patients between 20 and 40 years.2

The etiology of HS is not clear, although a combination of factors are thought to be involved in the pathophysiology of the disorder, including aberrant immunity, hormonal dysregulation, and genetic predisposition.1,2


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Several comorbidities are associated with HS, including metabolic disease, diabetes, polycystic ovarian syndrome (PCOS), cardiovascular disease, current or past smoker, squamous cell carcinoma, and anxiety/depression.2 Reddy et al found a 2-fold increase in overall comorbidity burden, as measured using the Charlson Comorbidity Index (CCI), in patients with HS.4 The CCI is a validated standardized measure of global comorbidity and is associated with short- and long-term mortality across various populations in the outpatient setting.4,5 

A significant portion (13.5%) of patients with HS in the study had a CCI score of 5 or greater, which was associated with a nearly 5-fold increase in 5-year mortality risk compared with patients with HS and a CCI score of 0.4 The degree of morbidity burden and increased mortality among HS patients suggests the need for multidisciplinary implementation of screening measures that support prevention and early detection in this population.4

Until recently, formal guidelines for the management of HS have been limited; however, the North American and Canadian Hidradenitis Suppurativa Foundations recently released guidelines for clinical evaluation, treatment, and management of this disease. Comorbidity screening is a key element of these guidelines (Table 1).2

Table 1. Guidelines for Comorbidity Screening in Hidradenitis Suppurativa2

StepRecommendation
Perform review of systems and physical examinationScreen for metabolic syndrome, depression, anxiety, type 2 diabetes, PCOS, and tobacco abuse
Identify patients with additional diabetes risk factorsRefer patients with risk factors for diabetes (eg, obesity, hypertension, hyperlipidemia, and acanthosis nigricans) for HbA1c and/or fasting glucose testing
Screen for comorbiditiesScreen for depression, inflammatory bowel disease, autoinflammatory syndromes, and inflammatory arthropathy based on review of systems
HbA1c, hemoglobin A1c; PCOS, polycystic ovarian syndrome.