Delayed Diagnosis of Hidradenitis Suppurativa and Its Effect on Patients and Healthcare System.
Adolescent
Adult
Age of Onset
Aged
Comorbidity
Cross-Sectional Studies
Delayed Diagnosis
/ psychology
Delivery of Health Care
Depression
/ etiology
Dermatologic Surgical Procedures
/ statistics & numerical data
Diagnostic Errors
/ statistics & numerical data
Employment
/ statistics & numerical data
Female
Germany
/ epidemiology
Hidradenitis Suppurativa
/ diagnosis
Humans
Male
Middle Aged
Non-Smokers
/ statistics & numerical data
Prospective Studies
Referral and Consultation
/ statistics & numerical data
Severity of Illness Index
Time Factors
Young Adult
Acne inversa
Comorbidity
Diagnosis
Healthcare system
Hidradenitis suppurativa
Journal
Dermatology (Basel, Switzerland)
ISSN: 1421-9832
Titre abrégé: Dermatology
Pays: Switzerland
ID NLM: 9203244
Informations de publication
Date de publication:
2020
2020
Historique:
received:
18
02
2020
accepted:
26
04
2020
pubmed:
2
7
2020
medline:
20
7
2021
entrez:
2
7
2020
Statut:
ppublish
Résumé
Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients experience metabolic, musculoskeletal, and psychological disorders. To determine the delay in HS diagnosis and its consequences for patients and the healthcare system. This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated. The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians - most frequently general practitioners, dermatologists, surgeons, gynecologists - and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed. This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.
Sections du résumé
BACKGROUND
BACKGROUND
Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients experience metabolic, musculoskeletal, and psychological disorders.
OBJECTIVES
OBJECTIVE
To determine the delay in HS diagnosis and its consequences for patients and the healthcare system.
METHODS
METHODS
This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated.
RESULTS
RESULTS
The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians - most frequently general practitioners, dermatologists, surgeons, gynecologists - and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed.
CONCLUSION
CONCLUSIONS
This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.
Identifiants
pubmed: 32610312
pii: 000508787
doi: 10.1159/000508787
pmc: PMC7592906
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
421-430Informations de copyright
© 2020 The Author(s) Published by S. Karger AG, Basel.
Références
JAMA Dermatol. 2018 Apr 1;154(4):447-451
pubmed: 29466546
PLoS One. 2012;7(2):e31810
pubmed: 22359634
J Am Acad Dermatol. 2016 Oct;75(4):755-759.e1
pubmed: 27453539
J Am Acad Dermatol. 2015 Oct;73(4):609-14
pubmed: 26190241
J Am Acad Dermatol. 2007 Apr;56(4):621-3
pubmed: 17097366
Cardiovasc Res. 2019 Mar 15;115(4):721-728
pubmed: 30721933
Br J Dermatol. 2014 Oct;171(4):819-24
pubmed: 24804604
Ann Dermatol Venereol. 2018 May;145(5):331-338
pubmed: 29704958
Br J Dermatol. 2017 Apr;176(4):1083-1085
pubmed: 27480611
Nat Rev Rheumatol. 2018 Aug;14(8):453-466
pubmed: 30006601
J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S47-51
pubmed: 26470616
Br J Dermatol. 2016 Mar;174(3):514-21
pubmed: 26436522
Dermatology. 2016;232(5):606-612
pubmed: 27649417
Br J Dermatol. 2017 Nov;177(5):1385-1393
pubmed: 28256718
Int J Colorectal Dis. 1998;13(4):164-8
pubmed: 9810520
Br J Dermatol. 2011 Jun;164(6):1292-8
pubmed: 21332464
JAMA Dermatol. 2016 Apr;152(4):429-34
pubmed: 26885728
Mediators Inflamm. 2016;2016:4097574
pubmed: 27843200
Br J Dermatol. 2018 Mar;178(3):761-767
pubmed: 28975626
Atherosclerosis. 2016 Aug;251:25-30
pubmed: 27236353
J Am Acad Dermatol. 2012 Sep;67(3):422-8, 428.e1
pubmed: 22182915
Br J Dermatol. 2018 Apr;178(4):917-924
pubmed: 29094346
J Am Acad Dermatol. 2010 Apr;62(4):706-8, 708.e1
pubmed: 20227585
J Rheumatol. 2014 Mar;41(3):490-4
pubmed: 24429166
Rev Endocr Metab Disord. 2016 Sep;17(3):335-341
pubmed: 27294593
J Invest Dermatol. 2019 Jun;139(6):1294-1305
pubmed: 30528824
Semin Immunopathol. 2019 May;41(3):359-377
pubmed: 31028434
JAMA Dermatol. 2014 Dec;150(12):1273-80
pubmed: 25229996
Front Immunol. 2018 Apr 05;9:579
pubmed: 29675020
Br J Dermatol. 2018 Mar;178(3):709-714
pubmed: 28960235
J Immunol. 2011 Jan 15;186(2):1228-39
pubmed: 21148041
Br J Dermatol. 2015 Dec;173(6):1546-9
pubmed: 26198191
Nat Rev Dis Primers. 2020 Mar 12;6(1):18
pubmed: 32165620