HİDRADENİTİS SÜPÜRATİVA HASTALARININ EPİDEMİYOLOJİK VE KLİNİK ÖZELLİKLERİ: ÜÇÜNCÜ BASAMAK BİR MERKEZİN 10 YILLIK DENEYİMİ

Year 2023, Volume: 86 Issue: 3, 235 - 244, 26.10.2023

Selda Işık Mermutlu , Zeynep Keskinkaya

https://doi.org/10.26650/IUITFD.1216589

Abstract

Amaç: Bu çalışmada hidradenitis süpürativa (HS) hastalarının epidemiyolojik ve klinik özelliklerinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Üçüncü basamak bir merkezde yürütülen bu retrospektif kesitsel çalışmada, 2012-2022 tarihlerinde tanı alan ve/veya takip edilen HS hastaları demografik özellikler, klinik bulgular, eşlik eden komorbiditeler, HS için verilen tedaviler ve tedavi yanıtları açısından değerlendirilmiştir.
Bulgular: 101 HS hastasının (erkek:kadın oranı=1,7:1) %23,3’ünde (n=20) erken başlangıç (<18 yaş) öyküsü mevcuttu. Hastaların büyük çoğunluğunda (%82,7; n=62) ailede HS öyküsü yoktu. Hastaların hastalık şiddetine göre dağılımları Hurley I (%33,7; n=34), Hurley II (%46,5; n=47), Hurley III (%19,8; n=20) şeklindeydi. Erken başlangıçlı ve Hurley III HS hastalarında anlamlı ölçüde daha fazla anatomik bölge tutulumu saptandı (p<0,05). En sık tutulum görülen anatomik yerleşim aksiller bölge (n=78) olup, bunu inguinal (n=57) ve gluteal bölge (n=23) takip etmekteydi. Altmışdört hasta (%74,4) kilolu/obez olup hastaların %84,5’inde (n=71) güncel/geçmiş sigara kullanım öyküsü mevcuttu. HS’e en sık eşlik eden dermatolojik hastalık akne vulgaristi (n=23). Olguların %25,5’inde (n=25) pilonidal sinüs hastalığı mevcuttu. Hurley III HS hastaları önemli ölçüde daha yüksek oranda pilonidal sinüs hastalığı, gluteal ve perianal bölge tutulumu ile başvurdu (p<0,05). Ondokuz hasta metabolik sendrom tanısı almıştı. Sistemik antibiyotikler en sık reçete edilen birinci basamak ajanlardı. Hidradenitis Süpürativa Klinik Yanıtı (HiSCR) en yüksek oranda biyolojik ajanlarla (özellikle adalimumab) gözlendi
Sonuç: Mevcut literatür ile uyumlu olarak, HS ilişkili olduğu komorbiditeler ile birlikte hastalık yükünü arttırmaktadır. HS hastalarımızda erkek cinsiyet baskınlığı ve anatomik tutulum paternleri daha önce bildirilen Türk serileri ile uyumludur. Pilonidal sinüs hastalığı, gluteal ve perianal bölge tutulumu HS hastalarında şiddetli hastalık açısından yakın zamanlı çalışmalarda da vurgulanan önemli belirtilerdir. Biyolojik ajanlar, özellikle şiddetli HS formlarında, HiSCR sağlamak için en iyi tedavi seçeneği olarak görünmektedir.

Keywords

Hidradenitis süpürativa, Hurley, kronik inflamasyon, metabolik sendrom, pilonidal sinüs

EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF HIDRADENITIS SUPPURATIVA PATIENTS: 10-YEAR EXPERIENCE FROM A SINGLE TERTIARY CENTER

Abstract

Objective: To investigate the clinico-epidemiological profile of hidradenitis suppurativa (HS) patients.
Material and Method: In this retrospective cross-sectional single tertiary center study, the HS patients diagnosed and/or followed up between 2012-2022 were evaluated regarding demographic features, clinical findings, associated comorbidities, therapies initiated for HS and their outcomes.
Results: Of 101 HS patients (male:female ratio=1.7:1), 23.3% (n=20) had a history of early-onset disease (<18 years). The majority had no family history of HS (82.7%, n=62). The patients were classified according to disease severity as Hurley I (33.7%, n=34), Hurley II (46.5%, n=47) and Hurley III (19.8%, n=20). Patients with early-onset disease and Hurley III HS had a significantly higher number of affected anatomical sites (p<0.05). The axillary region was the most commonly involved anatomical site (n=78), followed by the inguinal (n=57) and gluteal regions (n=23). Sixty-four patients (74.4%) were overweight/obese, and 84.5% (n=71) were current or ex-smokers. Acne vulgaris was the main dermatological comorbidity associated with HS (n=23). Pilonidal sinus disease was present in 25.5% (n=25). Patients with Hurley III HS presented with significantly higher rates of pilonidal sinus disease and involvement of the gluteal and perianal regions (p<0.05). Nineteen patients were diagnosed with metabolic syndrome. Systemic antibiotics were the most frequently prescribed first-line agents. Hidradenitis Suppurativa Clinical Response (HiSCR) achievement was observed most frequently with biologics, particularly adalimumab.
Conclusion: In line with the current literature, HS poses an increased disease burden with its associated comorbidities. The predominance of the male sex and the anatomical involvement patterns seen in our HS patients are compatible with previously reported Turkish series. Pilonidal sinus disease and involvement of the gluteal and perianal regions in HS patients are important signs of severe disease, also highlighted in recent studies. The biologic agents seem to be the best therapeutic option for achieving HiSCR, especially in severe HS forms.

Keywords

Hidradenitis suppurativa, Hurley, chronic inflammation, metabolic syndrome, pilonidal sinus

References

• 1. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol 2020;82(5):1045-58. [CrossRef] google scholar
• 2. Dessinioti C, Tzanetakou V, Zisimou C, Kontochristopoulos G, Antoniou C. A retrospective study of the characteristics of patients with early-onset compared to adult-onset hidradenitis suppurativa. Int J Dermatol 2018;57(6):687-91. [CrossRef] google scholar
• 3. Vankeviciute RA, Polozovaite B, Trapikas J, Raudonis T, Grigaitiene J, Bylaite-Bucinskiene M. A 12-Year experience of hidradenitis suppurativa management. Adv Skin Wound Care 2019;32(1):1-7. [CrossRef] google scholar
• 4. Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD. Hidradenitis suppurativa and metabolic syndrome: a comparative cross-sectional study of 3207 patients. Br J Dermatol 2015;173(2):464-70. [CrossRef] google scholar
• 5. Mintoff D, Benhadou F, Pace NP, Frew JW. Metabolic syndrome and hidradenitis suppurativa: epidemiological, molecular, and therapeutic aspects. Int J Dermatol 2022;61(10):1175-86. [CrossRef] google scholar
• 6. Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, et al. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol 2009;61(1):51-7. [CrossRef] google scholar
• 7. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Current and emerging treatments. J Am Acad Dermatol 2020;82(5):1061-82. [CrossRef] google scholar
• 8. Garg A, Malviya N, Strunk A, Wright S, Alavi A, Alhusayen R, et al. Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol 2022;86(5):1092-101. [CrossRef] google scholar
• 9. Yüksel M, Basım P. Demographic and clinical features of hidradenitis suppurativa in Turkey. J Cutan Med Surg 2020;24(1):55-9. [CrossRef] google scholar
• 10. Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol 2015;29(4):619-44. [CrossRef] google scholar
• 11. Kimball AB, Sobell JM, Zouboulis CC, Gu Y, Williams DA, Sundaram M, et al. HiSCR (Hidradenitis Suppurativa Clinical Response): a novel clinical endpoint to evaluate therapeutic outcomes in patients with hidradenitis suppurativa from the placebo-controlled portion of a phase 2 adalimumab study. J Eur Acad Dermatol Venereol 2016;30(6):989-94. [CrossRef] google scholar
• 12. Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos-Bourboulis EJ, Fabbrocini G, et al. What causes hidradenitis suppurativa?-15 years after. Exp Dermatol 2020;29(12):1154-70. [CrossRef] google scholar
• 13. Özkur E, Karadağ AS, Üstüner P, Aksoy B, Eşme P, Çalışkan E, et al. Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity. Clin Exp Dermatol 2021;46(3):532- 40. [CrossRef] google scholar
• 14. Vural S, Gündoğdu M, Akay BN, Boyvat A, Erdem C, Koçyiğit P, et al. Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatol Ther 2019;32(5):e13003. [CrossRef] google scholar
• 15. Chandran NS, Lee JH, Kurokawa I. Hidradenitis suppurativa in South-East Asia and East Asia. Exp Dermatol 2021;30 Suppl 1:23-6. [CrossRef] google scholar
• 16. Shih T, Seivright JR, McKenzie SA, Harview CL, Truong AK, Shi VY, et al. Gender differences in hidradenitis suppurativa characteristics: A retrospective cohort analysis. Int J Womens Dermatol 2021;7(5Part B):672-4. [CrossRef] google scholar
• 17. Schrader AM, Deckers IE, van der Zee HH, Boer J, Prens EP. Hidradenitis suppurativa: a retrospective study of 846 Dutch patients to identify factors associated with disease severity. J Am Acad Dermatol 2014;71(3):460-7. [CrossRef] google scholar
• 18. Deckers IE, van der Zee HH, Boer J, Prens EP. Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement. J Am Acad Dermatol 2015;72(3):485-8. [CrossRef] google scholar
• 19. Seyed Jafari SM, Knüsel E, Cazzaniga S, Hunger RE. A retrospective cohort study on patients with hidradenitis suppurativa. Dermatology 2018;234(1-2):71-8. [CrossRef] google scholar
• 20. Peterson GC, Preston A, Frieder J, Wang X, Paek SY. Analysis of characteristics and trends in treatment response of hidradenitis suppurativa patients: A Southern US cohort study. Dermatology 2020;236(5):413- 20. [CrossRef] google scholar
• 21. Yang JH, Moon J, Kye YC, Kim KJ, Kim MN, Ro YS, et al. Demographic and clinical features of hidradenitis suppurativa in Korea. J Dermatol 2018;45(12):1389-95. [CrossRef] google scholar
• 22. Kurokawa I, Hayashi N, Japan Acne Research Society. Questionnaire surveillance of hidradenitis suppurativa in Japan. J Dermatol 2015;42(7):747-9. [CrossRef] google scholar
• 23. Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol 2013;133(1):97- 103. [CrossRef] google scholar
• 24. Bettoli V, Naldi L, Cazzaniga S, Zauli S, Atzori L, Borghi A, et al. Overweight, diabetes and disease duration influence clinical severity in hidradenitis suppurativa-acne inversa: evidence from the national Italian registry. Br J Dermatol 2016;174(1):195-7. [CrossRef] google scholar
• 25. Saunte DM, Boer J, Stratigos A, Szepietowski JC, Hamzavi I, Kim KH, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol 2015;173(6):1546-9. [CrossRef] google scholar
• 26. Marzano AV, Genovese G, Casazza G, Moltrasio C, Dapavo P, Micali G, et al. Evidence for a ‘window of opportunity’ in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicentre cohort study. Br J Dermatol 2021;184(1):133-40. [CrossRef] google scholar
• 27. Preda-Naumescu A, Ahmed HN, Mayo TT, Yusuf N. Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations. Int J Dermatol 2021;60(11):e449-58. [CrossRef] google scholar
• 28. Benhadou F, Van der Zee HH, Pascual JC, Rigopoulos D, Katoulis A, Liakou AI, et al. Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients. Br J Dermatol 2019;181(6):1198-206. [CrossRef] google scholar
• 29. Ingram JR. The epidemiology of hidradenitis suppurativa. Br J Dermatol 2020;183(6):990-8. [CrossRef] google scholar
• 30. Duman K, Gırgın M, Harlak A. Prevalence of sacrococcygeal pilonidal disease in Turkey. Asian J Surg 2017;40(6):434-7. [CrossRef] google scholar
• 31. Kimball AB, Sundaram M, Gauthier G, Guérin A, Pivneva I, Singh R, et al. The comorbidity burden of hidradenitis suppurativa in the United States: A claims data analysis. Dermatol Ther (Heidelb) 2018;8(4):557-69. [CrossRef] google scholar
• 32. Zouboulis CC, Bechara FG, Dickinson-Blok JL, Gulliver W, Horváth B, Hughes R, et al. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol 2019;33(1):19-31. [CrossRef] google scholar
• 33. Tsentemeidou A, Sotiriou E, Vakirlis E, Sideris N, Lallas A, Ioannides D. Treatment strategies for hidradenitis suppurativa: real-life data from a tertiary Greek hospital. Arch Dermatol Res 2022;314(3):301-5. [CrossRef] google scholar