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Prevalence Of Autoimmune Disease In Patients With Hidradenitis Suppurativa Seen In Ambulatory Settings From 2008 - 2017
Pragna N. Shetty1, Erinolaoluwa Araoye, BS1, Pooja S. Yesantharao, MS1, Adrienne R. Kambouris, BS1, Leen El Eter, BS1, C. Scott Hultman, MD, MBA1, Oluseyi Aliu, MD, MS2.
1The Johns Hopkins School of Medicine the Department of Plastic and Reconstructive Surgery, Baltimore, MD, USA, 2The Johns Hopkins School of Medicine the Department of Plastic and Reconstructive Surgery, Raleigh, NC, USA.

Purpose: Hidradenitis suppurativa (HS) is estimated to affect almost 4.1% of the U.S. population and has been thought to be the result of a progressive, inflammatory disease of the apocrine glands. Recent case studies have shown a possible link between HS and autoimmune diseases, including systemic lupus erythematosus (SLE), Type 1 diabetes mellitus (T1DM), autoimmune thyroiditis, and inflammatory bowel disease (IBD), as well as a link to diseases that contribute to or are associated with autoimmune diseases, such as metabolic syndrome and polycystic ovarian syndrome (PCOS). In this study, we sought to analyze the prevalence ratios between HS and these conditions.
Methods: We used the Healthcare Cost and Utilization Project's (HCUP) State Ambulatory Surgery and Services databases (SASD) for Maryland from 2008 - 2017. We identified all adult patients who had been diagnosed with HS using ICD9 705.83 and ICD10 L73.2. A literature review was conducted to identify cases of autoimmune and autoimmune-related diseases that occur with HS. Patients with HS were compared to a control group of patients who were not diagnosed with HS.
Results: Our cohort included 44,815 patients, 4,303 of whom were diagnosed with HS. Median age was 48 (29 - 62) with 23,166 (51.7%) females and 21,644 (49.3%). The prevalence ratio of SLE was 1.91, indicating that patients with HS are almost twice as likely to have SLE (P = 0.03). Patients with HS were 22.6 times as likely to have PCOS and 12.6 times as likely to have IBD (P < 0.001; Figure 1). HS patients were 6.2 times as likely to have metabolic syndrome than their control counterparts (P = 0.01). HS patients were not significantly different from the control group in likelihood of T1DM or autoimmune thyroiditis (Figure 1).

Conclusions: HS has previously been thought to be an inflammatory disease of the apocrine sweat glands. However, recent cases in the literature may indicate an autoimmune component to the disease. In this study of autoimmune diseases that have been linked to HS, we found that patients with HS were associated with significantly higher likelihood of IBD, SLE, metabolic syndrome, and PCOS than patients without HS. However, there was no significant difference of prevalent autoimmune thyroiditis or T1DM between HS patients and non-HS patients. This suggests there may be an autoimmune component to HS, and further research is needed to elucidate the relationship between HS and autoimmune disease.


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