Examining Clinical Characteristics of Hidradenitis Suppurativa in Older Adults

Older adults with hidradenitis suppurativa (HS) are more likely to present with advanced disease at diagnosis compared with younger counterparts, as well as report a high prevalence of comorbidities previously associated with HS. Findings were reported in a research letter published in JAMA Dermatology.

Characterized by recurrent painful nodules, abscesses, and tunnels primarily in intertriginous cutaneous zones, HS is a chronic inflammatory condition that is relatively uncommon in older adults.

Incidence rates of HS has been reported to decrease after menopause among women, but findings of a prior study investigating prevalence of the disease in people of Olmsted County, Minnesota, showed that declines in prevalence did not occur until after the 70-79 age group in women. Moreover, highest prevalence of HS in men occured in those aged 60-69 years from the same county.

“Certain subgroups of patients, such as those living with HIV and pediatric patients, have been characterized, but reports on HS in adults 65 years or older are lacking,” said the study authors.

They conducted a prospective analysis of data derived from patients with HS in a specialty clinic to further describe the clinical presentation, disease severity, associated comorbidities, and management of HS in older adults.

Following University of North Carolina institutional review board approval, data were collected from a total of 26 adults aged 65 years or older and 1122 adults younger than 65 years at enrollment. Patients aged 65 years or older underwent retrospective electronic medical record review to elicit additional data.

Among the study cohort, age at disease onset was found to be significantly higher in older adults vs those younger than 65 years (mean [SD], 41.8 [18.9] vs 20.1 [9.4] years; P < .001), as was age at HS diagnosis (mean [SD], 58.6 [12.8] vs 27.7 [11.5] years; P < .001). Older adults were also more likely to be current (11 [42%] vs 215 [19%]) or former (8 [31%] vs 221 [20%]; P = .001) smokers and male (10 [39%] vs 236 [21%]; P = .03). No significant phenotypic differences were observed between groups.

The logistic regression analyses demonstrated greater risk of being diagnosed with higher HS severity (measured via Hurley stage III disease) among older White adults (OR, 8.7; 95% CI, 2.5-29.8), Black older adults (OR, 3.27; 95% CI, 1.1-9.7), and Black younger adults (OR, 3.6; 95% CI, 2.6-4.8), compared with White younger adults.

Furthermore, older adults exhibited a high prevalence of comorbidities previously associated with HS, including hypertension, dyslipidemia, type 2 diabetes, and obesity.

“Hurley 3 disease was particularly prevalent in older adults, which may reflect extensive tunnels and scars persisting into older age. Higher Hurley stage III rates in Black patients of all ages may reflect underdiagnosis and undertreatment, though these patients could be predisposed to advanced disease for reasons currently unclear,” noted researchers.

Regarding therapeutic management, the most common medical treatments for older adults included systemic antibiotics (23 [88%]) and biologics (20 [77%]). Surgical excision and deroofing were also used in 12 patients aged 65 years or older (46%), and 2 deaths (8%), 2 cancer diagnoses (8%), 1 wound infection (4%), and 1 shingles diagnosis (4%) occurred.

Researchers acknowledged that a limitation of the analysis was the use of a relatively small cohort evaluated by a single dermatologist specializing in HS at an academic center. Most of the data were prospectively collected, but limited additional follow-up data were retrospective with few missing data points, they added.

“Because older adult patients commonly present with Hurley 2/3 disease, aggressive management is often required,” concluded the study authors. “Together, these findings should reassure clinicians when escalating care for older patients with HS.”

Reference

Blum FR, DeBarmore BM, Sayed CJ. Hidradenitis Suppurativa in Older Adults. JAMA Dermatol. Published online December 14, 2022. doi:10.1001/jamadermatol.2022.5390