Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations

• Type of Material: Article
• Authors: Amit Garg, Donald and Barbara Zucker School of Medicine at Hofstra; Neeta Malviya, Donald and Barbara Zucker School of Medicine at Hofstra; Andrew Strunk, Donald and Barbara Zucker School of Medicine at Hofstra; Shari Wright, Donald and Barbara Zucker School of Medicine at Hofstra; Afsaneh Alavi, University of Toronto; Raed Alhusayen, University of Toronto; Ali Alikhan, Sutter Medical Foundation; Steven D Daveluy, Wayne State University; Isabelle Delorme, Dr Isabelle Delorme Inc; Noah Goldfarb, Minneapolis Veterans Affairs Health Care System; Wayne Gulliver, Memorial University Newfoundland; Iltefat Hamzavi, Henry Ford Hospital; Tarannum Jaleel, Duke University; Alexa B Kimball, Beth Israel Deaconess Medical Center; Joslyn S Kirby, Penn State Milton S Hershey Medical Center; Mark G Kirchhof, University of Ottawa; Janice Lester, Donald and Barbara Zucker School of Medicine at Hofstra; Hadar Lev-Tov, University of Miami; Michelle A Lowes, Rockefeller University; Robert Micheletti, University of Pennsylvania; Lauren Orenstein, Emory University; Vincent Piguet, University of Toronto; Christopher Sayed, University of North Carolina; Jerry Tan, University of Western Ontario; Haley B Naik, University of California San Francisco
• Language: English
• Date: 2022-05-01
• Publisher: MOSBY-ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 by the American Academy of Dermatology, Inc. Published by Elsevier Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jaad.2021.01.059
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
• Volume: 86
• Issue: 5
• Start Page: 1092
• End Page: 1101
• Grant/Funding Information: Dr Orenstein is supported in part by Building Interdisciplinary Research Careers in Women’s Health of the National Institutes of Health (K12D085850).; Dr Naik is supported in part by the National Institutes of Health (NIAMS K32 AR074531).
• Keywords: diabetes mellitus; inflammatory bowel disease; pilonidal disease; substance use; sexual dysfunction; smoking; generalized anxiety disorder; North America; POPULATION; DEPRESSION; herpes zoster; spondyloarthritis; ASSOCIATION; HEALTH; obesity; acne; RISK; Life Sciences & Biomedicine; INFLAMMATORY-BOWEL-DISEASE; BURDEN; comorbidity; dissecting cellulitis of the scalp; lymphoma; hypertension; systemic; Crohn's disease; Science & Technology; metabolic syndrome; COHORT; suicide; PREVALENCE; dyslipidemia; depression; pyoderma gangrenosum; hidradenitis suppurativa; Dermatology; polycystic ovary syndrome; ulcerative colitis; guidelines; cardiovascular disease; screening; down syndrome; dermatologist; METABOLIC SYNDROME

Abstract

Background: Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk. Objective: To provide evidence-based screening recommendations for comorbidities linked to HS. Methods: Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria. Results: Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity. Limitations: Screening recommendations represent one component of a comprehensive care strategy. Conclusions: Dermatologists should support screening efforts to identify comorbid conditions in HS.