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

• Authors: Lauren Orenstein, Emory University; A Garg, Donald & Barbara Zucker Sch Med Hofstra Northwell; N Malviya, Donald & Barbara Zucker Sch Med Hofstra Northwell; A Strunk, Donald & Barbara Zucker Sch Med Hofstra Northwell; S Wright, Donald & Barbara Zucker Sch Med Hofstra Northwell; A Alavi, University of Toronto; R Alhusayen, University of Toronto; A Alikhan, Sutter Med Fdn; SD Daveluy, Wayne State University; I Delorme, Dr Isabelle Delorme Inc; N Goldfarb, Minneapolis Vet Affairs Hlth Care Syst; W Gulliver, Memorial University Newfoundland; I Hamzavi, Henry Ford Hospital; T Jaleel, Duke University; AB Kimball, Beth Israel Deaconess Med Ctr; JS Kirby, Penn State Milton S Hershey Med Ctr; MG Kirchhof, University of Ottawa; J Lester, Donald & Barbara Zucker Sch Med Hofstra Northwell; H Lev-Tov, University of Miami; MA Lowes, Rockefeller University; R Micheletti, University of Pennsylvania; V Piguet, University of Toronto; C Sayed, University of North Carolina; J Tan, Univ Western Ontario; HB Naik, University of California San Francisco
• Journal Title: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
• Volume: Volume 86, Number 5
• Publisher: MOSBY-ELSEVIER | 2022-05-01, Pages 1092-1101
• Type of Work: Article
• Publisher DOI: http://doi.org/10.1016/j.jaad.2021.01.059
• Keywords: Science & Technology; Life Sciences & Biomedicine; Dermatology; acne; cardiovascular disease; comorbidity; Crohn's disease; depression; dermatologist; diabetes mellitus; dissecting cellulitis of the scalp; down syndrome; dyslipidemia; generalized anxiety disorder; guidelines; herpes zoster; hidradenitis suppurativa; hypertension; inflammatory bowel disease; lymphoma; metabolic syndrome; North America; obesity; pilonidal disease; polycystic ovary syndrome; pyoderma gangrenosum; screening; sexual dysfunction; smoking; spondyloarthritis; substance use; suicide; systemic; ulcerative colitis; INFLAMMATORY-BOWEL-DISEASE; METABOLIC SYNDROME; PREVALENCE; RISK; POPULATION; HEALTH; ASSOCIATION; DEPRESSION; BURDEN; COHORT

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.