Higher Prevalence of Depression, Other Comorbidities in Patients with Hidradenitis Suppurativa

Olayemi Sokumbi, MD

A 15-year population-based study from Minnesota found that patients affected by hidradenitis suppurativa had a significantly higher frequency of depression, anxiety, acne conglobate, diabetes, and several other medical conditions.

The study was specific to Olmsted County, and was the first American population-based study examining the association between hidradenitis suppurativa and these various conditions.

The inflammatory disorder has only recently been associated with medical conditions such as obesity, inflammatory bowel disease (IBD), and various psychiatric disorders.

Investigators led by Olayemi Sokumbi, MD, of the Mayo Clinic, suggested that understanding these associations would be key to determining proper screening, laboratory testing, and referrals other disciplines for affected patients.

As such, Sokumbi and colleagues evaluated all available medical records of patients from Olmsted County, Minnesota, since the 1960s via the Rochester Epidemiology Project (REP).

Olmsted County has a population of 158,293, with 83.6% having been identified as White according to 2019 data.

They noted that the utilization of REP would be particularly useful regarding the isolation of the population, utilization by most health care providers, and all data points being entered directly by said providers.

The team searched the REP for medical records of patients from Olmsted County who received a diagnostic code for hidradenitis suppurativa from January 1, 2003 to December 31, 2018.

For each case that was identified, 1 age- and gender-matched control without hidradenitis suppurativa was also identified.

From there, the frequency of comorbid conditions between the 2 groups was compared, with continuous variables being compared using T-test.

The team identified 1160 patients with hidradenitis suppurativa and 1160 controls in their search of the REP. The mean age of diagnosis was 35 years, and 73% of all participants were female while 77.9% were White.

The percentage of patients who were White was lower in the hidradenitis suppurativa group (77.9% and 94.3%, respectively).

The hidradenitis suppurativa cohort was significantly more likely to have dermatologic comorbid conditions compared to the control group, including acne vulgaris (7.6% vs. 3.4%), atopic dermatitis (1.6% vs. 0.6%), dissecting cellulitis (6.1%vs.0.8%), pilonidalcyst/sinus(0.8%vs.0%), and psoriasis (2.1% vs. 0.8%).

Regarding endocrinologic and metabolic conditions, diabetes, hyperlipidemia, hypertension, PCOS, and thyroid disease all occurred more frequently in patients with hidradenitis suppurativa.

A notable discrepancy was observed regarding depression in both groups, as more patients with hidradenitis suppurativa suffered from the condition (23.6% vs. 15.3%) (P<.001). The same was true for all psychiatric and behavioral conditions including depression (23.6% vs.15.3%), sleep disturbances(9.7%vs.4.6%), substance use disorder (11.8% vs. 4.8%), and tobacco smoking (17.8% vs. 6.7%).

Notably, diagnosis of IBD (1.1% vs. 0.4%) or spondyloarthropathy (0.4% vs. 0.3%) was not significantly higher in patients with hidradenitis suppurativa.

Investigators noted that the results of the 15-year study were comprehensive and similar to those prior studies that demonstrated a significant burden of comorbid conditions in patients with the inflammatory condition.

“Discussion with the patient’s primary care physician regarding these comorbid conditions may be prudent and could translate into early management and prevention of complications,” the team wrote.

The study, "Comorbid diseases of Hidradenitis Suppurativa: a 15-Year Population-Based study in Olmsted County, Minnesota, USA," was published online in the International Journal of Dermatology.