Identification of Three Hidradenitis Suppurativa Phenotypes: Latent Class Analysis of a Cross-Sectional Study

Abstract

To identify the underlying subtypes of hidradenitis suppurativa (HS), we performed latent class analysis on prospective clinical data of 618 consecutive patients seen between 2002 and 2010. The median patient age was 31 years (Q1=26; Q3=38), median age at HS onset was 20 years (16-25), and median Sartorius score was 18 (11-19); 34.4% of patients were of Hurley stage II or III. A three-class model showed the best fit. Latent class 1 (LC1) patients (48%) had a high probability of breast and armpit lesions (0.74) and hypertrophic scars (0.41). LC2 patients (26%) had a high probability not only of breast and armpit lesions (0.96) but also of lesions in the ears, chest, back, or legs (0.55); follicular lesions (pilonidal sinus: 0.48; comedones: 0.74); severe acne (0.47); and a family history of HS (0.44). Compared with LC1 patients, LC2 patients were more often male (odds ratio, 4.6; 95% confidence interval, 3-7; P<0.001) and current smokers (2.2; 1.3-3.9; P=0.005), and had greater disease severity (odds ratio, 1.6; 1.3-1.9; P<0.001). LC3 was characterized by gluteal involvement (0.54), papules, and folliculitis (0.71). LC3 patients were less often obese (0.6; 0.3-0.95; P=0.03) and had less severe disease (0.9; 0.7-1.1; P<0.001). These three phenotypes ("axillary-mammary", "follicular", and "gluteal") may help stratify patients for clinical trials.

Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement

“…3,11 This supports the findings of previous studies that patients with a family history of HS develop HS at an earlier age. 5,11 It is conceivable that a genetic predisposition influences the age of onset.…”

“…1,2 Onset of HS is generally after puberty, typically between the ages of 20 and 24 years. [3][4][5] Prepubertal onset is estimated to occur in 2% of patients with HS. 6,7 When several of our patients reported onset of HS in their early teens, we sought to determine the prevalence of early-onset HS and to analyze the clinical characteristics of patients with HS in relation to the age of onset.…”

Should Hidradenitis Suppurativa Be Included in Dermatoses Showing Koebnerization? Is It Friction or Fiction?

“…Recently, 3 subpopulations were identified by latent class analysis [33] . Then, a subclassification was proposed, based on clinical experience, including the "frictional furuncle type" (patients with overweight; typical lesions on atypical locations, exposed to enhanced friction; tunneling is unusual) [34] .…”

Schweizer Praxisempfehlungen für die Behandlung der Hidradenitis suppurativa (Acne inversa)

“…Die häufigsten Lokalisationen sind Achselhöhlen und Leistengegend. Die bei Männern und Frauen typischerweise betroffenen Areale sind mitsamt Prävalenzen in Tabelle 1 aufgeführt [16,17]. In einigen Fällen sind auch atypisch lokalisierte Läsionen an Ohren, Brust oder Rücken zu beobachten [18].…”