Comorbidity screening in Hidradenitis Suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations

Abstract Background Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk. Objective To provide evidence-based screening recommendations for comorbidities linked to HS. Methods Systematic reviews were performed to summarize evidence on prevalence and incidence of 30 comorbidities in HS patients relative to the general population. Screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence and magnitude of association, as well as benefits, harms, and feasibility of screening. Level of evidence and strength of corresponding screening recommendation were graded using SORT criteria. Results Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovarian syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis and sexual dysfunction. It is also recommended to screen Down syndrome patients for HS. Decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity. Limitations Screening recommendations represent one component of a comprehensive care strategy. Conclusions Dermatologists should support screening efforts to identify comorbid conditions in HS.