Hidradenitis suppurativa: an update

Ingram, John R.

doi:10.7861/clinmedicine.16-1-70

Cited by 32 publications

(24 citation statements)

References 21 publications

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“…1,2 HS is defined clinically by characteristic lesions occurring chronically in flexural locations. 3,4 Consensus disease definitions differ slightly in the chronicity element, ranging from a history of two to five boils in the axillae or groins. 5,6 The prevalence of HS remains controversial, with estimates ranging from 0Á05% from an analysis of patient insurance claims in the U.S.A. 7 to 4% when young adult women were examined in person.…”

Section: Discussionmentioning

confidence: 99%

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

Ingram¹,

Jenkins‐Jones²,

Knipe³

et al. 2018

British Journal of Dermatology

122

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Summary Hidradenitis suppurativa (HS) is a long‐term skin disease affecting young adults, causing multiple boils in skin crease sites such as the armpits and groins. The boils are painful, may produce pus and leave disfiguring scars. How common HS is remains controversial, with recent reports using USA medical insurance data suggesting about 0.1% of the population is affected, which is lower than European studies using self‐reported questionnaires (completed by the patient). This may be because insurance databases miss undiagnosed cases. Our study team based in the UK aimed to use UK electronic data recorded by General Practitioners (GPs) to identify known and previously undiagnosed cases of HS. We identified undiagnosed cases by looking for patients who had seen their GP for at least 5 skin boils and validated their diagnosis by sending some of the GPs a questionnaire to double‐check. Out of 4.3 million patients in the GP database, we found 23,000 diagnosed HS patients and 10,000 undiagnosed patients, showing that 0.77% of the UK population has HS. Including probable cases, who had 1‐4 skin boil consultations, the figure rises to 1.19%. Comparing people with HS to similar people without HS, there are higher rates of smoking and obesity (both 3 times more common), as well as type 2 diabetes, Crohn's disease, raised fat levels in the blood, acne, high blood pressure and depression. However a link was not found between HS and ulcerative colitis or polycystic ovary syndrome. In conclusion, we found that HS is relatively common, nearly 10 times more common than the estimates using USA insurance data. People with HS have higher rates of risk factors for heart disease and stroke and so checking for these conditions is important.

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Section: Discussionmentioning

confidence: 99%

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

Ingram¹,

Jenkins‐Jones²,

Knipe³

et al. 2018

British Journal of Dermatology

122

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“…Hidradenitis suppurativa (HS) is a chronic skin disease characterized by painful inflammatory nodules and abscesses in flexural sites that exude pus and often lead to scarring. 1 Investigation of the epidemiology of HS is challenging because the diagnosis is often delayed or never formally established. Average diagnostic delay for HS is 7Á2 years, compared with 1Á6 years for psoriasis.…”

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confidence: 99%

The epidemiology of hidradenitis suppurativa*

Ingram¹

2020

Br. J. Dermatol.

123

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Summary Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined clinically by multiple, painful inflammatory lesions occurring predominantly in flexural sites. Onset is typically soon after puberty; however, it remains unknown whether the menopause induces remission. In North American and European patients with HS the female‐to‐male ratio is approximately 3 : 1 but the ratio is 1 : 2 in South Korean patients. It may be that some elements of HS epidemiology cannot be generalized across all populations. Elements of HS epidemiology in the USA and Europe are well established, including strong associations with obesity and smoking, which may increase disease severity. There are associations between HS and other cardiovascular disease (CVD) risk factors, including type 2 diabetes and metabolic syndrome. People with HS have double the risk of death from CVD compared with those without HS and 1·5 times the risk compared with patients with psoriasis. Depression and anxiety are associated with HS and completed suicide rates in those with HS are more than double the rates in controls. Associations exist between HS and other chronic inflammatory conditions, particularly inflammatory bowel disease and inflammatory arthritis. Case–control studies demonstrate associations with pilonidal sinus, polycystic ovary syndrome, Down syndrome, obstructive sleep apnoea and pyoderma gangrenosum. Population‐based studies using routinely collected healthcare data from the USA estimate a prevalence of 0·1%, suggesting HS is relatively uncommon. European studies include undiagnosed patients and typically estimate prevalence of 1% or more, suggesting a common condition. Resolving the controversy surrounding a greater than 10‐fold difference in HS prevalence estimates remains a high priority.

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“…Hidradenitis suppurativa (HS), also known as acne inversa, is an inflammatory skin disease producing functional impairment similar in magnitude to cardiovascular disease, type 2 diabetes and renal failure, because of pain, purulent discharge and scarring . HS is defined clinically by characteristic lesions occurring chronically in flexural locations . Consensus disease definitions differ slightly in the chronicity element, ranging from a history of two to five boils in the axillae or groins …”

mentioning

confidence: 99%

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

Ingram

Jenkins‐Jones²,

Knipe

et al. 2018

British Journal of Dermatology

181

132

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Summary Background Epidemiology data regarding hidradenitis suppurativa (HS) are conflicting and prevalence estimates vary 80‐fold, from 0·05% in a population‐based study to 4%. Objectives To assess the hypothesis that previous population‐based studies underestimated true HS prevalence by missing undiagnosed cases. Methods We performed a population‐based observational and case–control study using the U.K. Clinical Practice Research Datalink (CPRD) linked to hospital episode statistics data. Physician‐diagnosed cases in the CPRD were identified from specific Read codes. Algorithms identified unrecognized ‘proxy’ cases, with at least five Read code records for boils in flexural skin sites. Validation of proxy cases was undertaken with general practitioner (GP) questionnaires to confirm criteria‐diagnosed cases. A case–control study assessed disease associations. Results On 30 June 2013, 23 353 physician‐diagnosed HS cases were documented in 4 364 308 research‐standard records. In total, 68 890 proxy cases were identified, reduced to 10 146 criteria‐diagnosed cases after validation, extrapolated from 107 completed questionnaires (61% return rate). Overall point prevalence was 0·77% [95% confidence interval (CI) 0·76–0·78%]. An additional 18 417 cases had a history of one to four flexural skin boils. In physician‐diagnosed cases, odds ratios (ORs) for current smoker and obesity (body mass index > 30 kg m‐2) were 3·61 (95% CI 3·44–3·79) and 3·29 (95% CI 3·14–3·45). HS was associated with type 2 diabetes, Crohn disease, hyperlipidaemia, acne and depression, and not associated with ulcerative colitis or polycystic ovary syndrome. Conclusions Contrary to results of previous population‐based studies, HS is relatively common, with a U.K. prevalence of 0·77%, one‐third being unrecognized, criteria‐diagnosed cases using the most stringent disease definition. If individuals with probable cases are included, HS prevalence rises to 1·19%.

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Hidradenitis suppurativa: an update

Cited by 32 publications

References 21 publications

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

The epidemiology of hidradenitis suppurativa*

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

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