Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort
DOI:
https://doi.org/10.2340/actadv.v103.6569Keywords:
hidradenitis suppurativa, epidemiology, pilonidal sinus diseaseAbstract
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
Downloads
References
Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 2009; 60: 539-561.
https://doi.org/10.1016/j.jaad.2008.11.911 DOI: https://doi.org/10.1016/j.jaad.2008.11.911
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 Am Acad Dermatol 2019; 33: 19-31.
https://doi.org/10.1111/jdv.15233 DOI: https://doi.org/10.1111/jdv.15233
Montero-Vilchez T, Diaz-Calvillo P, Rodriguez-Pozo J-A, Cuenca-Barrales C, Martinez-Lopez A, Arias-Santiago S, et al. The burden of hidradenitis suppurativa signs and symptoms in quality of life: systematic review and meta-analysis. Int J Environ Res Public Health 2021; 18: 6709.
https://doi.org/10.3390/ijerph18136709 DOI: https://doi.org/10.3390/ijerph18136709
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: 1546-1549.
https://doi.org/10.1111/bjd.14038 DOI: https://doi.org/10.1111/bjd.14038
Jiang SW, Whitley MJ, Mariottoni P, Jaleel T, MacLeod AS. Hidradenitis suppurativa: host-microbe and immune pathogenesis underlie important future directions. J Invest Dermatol 2021; 1: 100001.
https://doi.org/10.1016/j.xjidi.2021.100001 DOI: https://doi.org/10.1016/j.xjidi.2021.100001
Nazary M, van der Zee HH, Prens EP, Folkerts G, Boer J. Pathogenesis and pharmacotherapy of Hidradenitis suppurativa. Eur J Pharmacol 2011; 672: 1-8.
https://doi.org/10.1016/j.ejphar.2011.08.047 DOI: https://doi.org/10.1016/j.ejphar.2011.08.047
Pillsbury DM, Shelley WB, Kligman AM. Bacterial infections of the skin. In: Pillsbury DM, editor. Dermatology. Philadelphia: WB Saunders; 1956, p. 482-484.
Plewig G. Acne morphogenesis and treatment. S.l.: Berlin: Springer; 2012.
Plewig G, Kligman AM. In: Plewig G, Kligman AM editors. Acne morphogenesis and treatment. Berlin: Springer; 1975, p. 190-192.
https://doi.org/10.1007/978-3-642-96246-2 DOI: https://doi.org/10.1007/978-3-642-96246-2
Mohanna PN, Flemming AFS, Al-Sam SZ. Subungual pilonidal sinus of the hand in a dog groomer. Br J Plast Surg 2001; 54: 176-178.
https://doi.org/10.1054/bjps.2000.3457 DOI: https://doi.org/10.1054/bjps.2000.3457
Patel MR, Bassini L, Nashad R, Anselmo MT. Barber's interdigital pilonidal sinus of the hand: A foreign body hair granuloma. J Hand Surg Am 1990; 15: 652-655.
https://doi.org/10.1016/S0363-5023(09)90031-4 DOI: https://doi.org/10.1016/S0363-5023(09)90031-4
Patey DH, Scarff RW. Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet 1946; 2: 484-486.
https://doi.org/10.1016/S0140-6736(46)91756-4 DOI: https://doi.org/10.1016/S0140-6736(46)91756-4
von Laffert M, Stadie V, Ulrich J, Marsch WC, Wohlrab J. Morphology of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa. Dermatology 2011; 223: 349-355.
https://doi.org/10.1159/000335373 DOI: https://doi.org/10.1159/000335373
Khanna A, Rombeau JL. Pilonidal disease. Clin Colon Rectal Surg 2011; 24: 46-53.
https://doi.org/10.1055/s-0031-1272823 DOI: https://doi.org/10.1055/s-0031-1272823
Boer J, Nazary M, Riis PT. The role of mechanical stress in hidradenitis suppurativa. Dermatol Clin 2016; 34: 37-43.
https://doi.org/10.1016/j.det.2015.08.011 DOI: https://doi.org/10.1016/j.det.2015.08.011
Wortsman X, Castro A, Morales C, Franco C, Figueroa A. Sonographic comparison of morphologic characteristics between pilonidal cysts and hidradenitis suppurativa: sonography of pilonidal cysts and hidradenitis. J Ultrasound Med 2017; 36: 2403-2418.
https://doi.org/10.1002/jum.14282 DOI: https://doi.org/10.1002/jum.14282
Lee JH, Kwon HS, Jung HM, Kim GM, Bae JM. Prevalence and comorbidities associated with hidradenitis suppurativa in Korea: a nationwide population-based study. J Eur Acad Dermatol 2018; 32: 1784-1790.
https://doi.org/10.1111/jdv.15071 DOI: https://doi.org/10.1111/jdv.15071
Ingram JR. The epidemiology of hidradenitis suppurativa. Br J Dermatol 2020; 183: 990-998.
https://doi.org/10.1111/bjd.19435 DOI: https://doi.org/10.1111/bjd.19435
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: 51-57.
https://doi.org/10.1016/j.jaad.2009.02.013 DOI: https://doi.org/10.1016/j.jaad.2009.02.013
Hua VJ, Kilgour JM, Cho HG, Li S, Sarin KY. Characterization of comorbidity heterogeneity among 13,667 patients with hidradenitis suppurativa. JCI Insight 2021; 6: e151872.
https://doi.org/10.1172/jci.insight.151872 DOI: https://doi.org/10.1172/jci.insight.151872
Schrader AMR, 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: 460-467.
https://doi.org/10.1016/j.jaad.2014.04.001 DOI: https://doi.org/10.1016/j.jaad.2014.04.001
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: 97-103.
https://doi.org/10.1038/jid.2012.255 DOI: https://doi.org/10.1038/jid.2012.255
Canoui-Poitrine F, Thuaut AL, Revuz JE, Viallette C, Gabison G, Poli F, et al. Identification of three hidradenitis suppurativa phenotypes: latent class analysis of a cross-sectional study. J Invest Dermatol 2013; 133: 1506-1511.
https://doi.org/10.1038/jid.2012.472 DOI: https://doi.org/10.1038/jid.2012.472
González-Manso A, Agut-Busquet E, Romaní J, Vilarrasa E, Bittencourt F, Mensa A, et al. Hidradenitis suppurativa: proposal of classification in two endotypes with two-step cluster analysis. Dermatology 2021; 237: 365-371.
https://doi.org/10.1159/000511045 DOI: https://doi.org/10.1159/000511045
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: 1198-1206.
https://doi.org/10.1111/bjd.17927 DOI: https://doi.org/10.1111/bjd.17927
Cazzaniga S, Pezzolo E, Bettoli V, Abeni D, Marzano AV, Patrizi A, et al. Characterization of hidradenitis suppurativa phenotypes: a multidimensional latent class analysis of the National Italian Registry IRHIS. J Invest Dermatol 2021; 141: 1236-1242.
https://doi.org/10.1016/j.jid.2020.08.032 DOI: https://doi.org/10.1016/j.jid.2020.08.032
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 2018; 8: 557-569.
https://doi.org/10.1007/s13555-018-0264-z DOI: https://doi.org/10.1007/s13555-018-0264-z
Yüksel M, Basım P. Demographic and clinical features of hidradenitis suppurativa in Turkey. J Cutan Med Surg 2020; 24: 55-59.
https://doi.org/10.1177/1203475419887732 DOI: https://doi.org/10.1177/1203475419887732
McMillan K. Diagnoses of hidradenitis suppurativa in the United States, 1979-2012. Skin Appendage Disord 2015; 1: 117-122.
https://doi.org/10.1159/000439438 DOI: https://doi.org/10.1159/000439438
Garg A, Lavian J, Lin G, Strunk A, Alloo A. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol 2017; 77: 118-122.
https://doi.org/10.1016/j.jaad.2017.02.005 DOI: https://doi.org/10.1016/j.jaad.2017.02.005
Kokolakis G, Wolk K, Schneider-Burrus S, Kalus S, Barbus S, Gomis-Kleindienst S, et al. Delayed diagnosis of hidradenitis suppurativa and its effect on patients and healthcare system. Dermatology 2020; 236: 421-430.
https://doi.org/10.1159/000508787 DOI: https://doi.org/10.1159/000508787
Lopes S, Vide J, Costa-Silva M, Azevedo F, Magina S. Awareness, knowledge, and practice patterns of general practitioner residents and specialists toward hidradenitis suppurativa: a survey study. Acta Dermatovenerol Alp Pannonica Adriat 2019; 28: 61-63.
https://doi.org/10.15570/actaapa.2019.16 DOI: https://doi.org/10.15570/actaapa.2019.16
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Clara Ureña-Paniego, Marta Gamissans-Cañada, Alejandro Molina-Leyva, Jorge Romaní
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
