Differentiating clinical characteristics of perianal inflammatory bowel disease from perianal hidradenitis suppurativa.
Crohn's disease
HS
IBD
clinical characteristics
features
fistula
hidradenitis suppurativa
inflammatory bowel disease
perianal
Journal
International journal of dermatology
ISSN: 1365-4632
Titre abrégé: Int J Dermatol
Pays: England
ID NLM: 0243704
Informations de publication
Date de publication:
22 Sep 2024
22 Sep 2024
Historique:
revised:
12
08
2024
received:
22
02
2024
accepted:
07
09
2024
medline:
22
9
2024
pubmed:
22
9
2024
entrez:
22
9
2024
Statut:
aheadofprint
Résumé
Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas. We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD. A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife-cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral. The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome.
Sections du résumé
BACKGROUND
BACKGROUND
Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas.
METHODS
METHODS
We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD.
RESULTS
RESULTS
A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife-cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral.
CONCLUSIONS
CONCLUSIONS
The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Japanese Society of Dermatology
Organisme : Department of Dermatology
Organisme : Mayo Clinic, Rochester, Minnesota
Organisme : Japanese Dermatological Association Grant-In-Aid for Study Abroad
Informations de copyright
© 2024 the International Society of Dermatology.
Références
Asgeirsson T, Nunoo R, Luchtefeld MA. Hidradenitis suppurativa and pruritus ani. Clin Colon Rectal Surg. 2011;24:71–80.
Mahadev S, Young JM, Selby W, Solomon MJ. Quality of life in perianal Crohn's disease: what do patients consider important? Dis Colon Rectum. 2011;54:579–585.
Wang CX, Buss JL, Keller M, Anadkat MJ. Factors associated with dermatologic follow‐up vs emergency department return in patients with hidradenitis suppurativa after an initial emergency department visit. JAMA Dermatol. 2022;158:1378–1386.
Yamamoto T, Nakase H, Watanabe K, Shinzaki S, Takatsu N, Fujii T, et al. Diagnosis and clinical features of perianal lesions in newly diagnosed Crohn's disease: subgroup analysis from inception cohort registry study of patients with Crohn's disease (iCREST‐CD). J Crohns Colitis. 2023;17:1193–1206.
Gotesman RD, Choi C, Alavi A. Hidradenitis suppurativa in East and Southeast Asian populations: a systematic review and meta‐analysis. Int J Dermatol. 2021;60:e433–e439.
Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan A. Comorbid diseases of hidradenitis suppurativa: a 15‐year population‐based study in Olmsted County, Minnesota, USA. Int J Dermatol. 2022;61:1372–1379.
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.
Shivashankar R, Tremaine WJ, Harmsen WS, Loftus EV Jr. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol. 2017;15:857–863.
Loftus EV Jr. Update on the incidence and prevalence of inflammatory bowel disease in the United States. Gastroenterol Hepatol (N Y). 2016;12:704–707.
Nakase H, Uchino M, Shinzaki S, Matsuura M, Matsuoka K, Kobayashi T, et al. Evidence‐based clinical practice guidelines for inflammatory bowel disease 2020. J Gastroenterol. 2021;56:489–526.
Phan K, Tatian A, Woods J, Cains G, Frew JW. Prevalence of inflammatory bowel disease (IBD) in hidradenitis suppurativa (HS): systematic review and adjusted meta‐analysis. Int J Dermatol. 2020;59:221–228.
Yadav S, Singh S, Edakkanambeth Varayil J, Harmsen WS, Zinsmeister AR, Tremaine WJ, et al. Hidradenitis suppurativa in patients with inflammatory bowel disease: a population‐based cohort study in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2016;14:65–70.
Garg A, Hundal J, Strunk A. Overall and subgroup prevalence of Crohn disease among patients with hidradenitis suppurativa: a population‐based analysis in the United States. JAMA Dermatol. 2018;154:814–818.
Jorgensen AR, Thomsen SF, Karmisholt KE, Ring HC. Clinical, microbiological, immunological and imaging characteristics of tunnels and fistulas in hidradenitis suppurativa and Crohn's disease. Exp Dermatol. 2020;29:118–123.
Strunk A, Midura M, Papagermanos V, Alloo A, Garg A. Validation of a case‐finding algorithm for hidradenitis suppurativa using administrative coding from a clinical database. Dermatology. 2017;233:53–57.
Brownlee J. Machine learning mastery with Python. Machine Learning Mastery Pty Ltd; 2016, 527, p. 100–120. (Independently published), ISBN‐13: 979‐8540446273.
van der Maaten L, Hinton G. Visualizing data using t‐SNE. J Mach Learn Res. 2008;9:2579–2605.
Ardon CB, Molenaar C, van Straalen KR, Scholtes VC, Prens EP, van der Zee HH. High prevalence of hidradenitis suppurativa in patients with perianal fistula. Int J Color Dis. 2019;34:1337–1339.
Panés J, Rimola J. Perianal fistulizing Crohn's disease: pathogenesis, diagnosis and therapy. Nat Rev Gastroenterol Hepatol. 2017;14:652–664.
Wiltz O, Schoetz DJ Jr, Murray JJ, Roberts PL, Coller JA, Veidenheimer MC. Perianal hidradenitis suppurativa. The Lahey Clinic experience. Dis Colon Rectum. 1990;33:731–734.
Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med. 2001;135:906–918.
Pogacnik JS, Salgado G. Perianal Crohn's Disease. Clin Colon Rectal Surg. 2019;32:377–385.
Shi V, Hsiao J, Lowes M, Hamzavi I. A comprehensive guide to hidradenitis suppurativa. Vol 368. Philadelphia: Elsevier; 2021.
Barrick BJ, Tollefson MM, Schoch JJ, McEvoy MT, Hand JL, Wieland CN, et al. Penile and scrotal swelling: an underrecognized presentation of Crohn's disease. Pediatr Dermatol. 2016;33:172–177.
Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology. 2002;122:875–880.
Yamanaka‐Takaichi M, Revankar R, Shih T, Gall M, Hsiao JL, Shi VY, et al. Expert consensus on priority research gaps in dietary and lifestyle factors in hidradenitis suppurativa: a Delphi consensus study. Arch Dermatol Res. 2023;315:2129–2136.
Jorgensen AR, Aarestrup J, Baker JL, Thomsen SF. Association of birth weight, childhood body mass index, and height with risk of hidradenitis suppurativa. JAMA Dermatol. 2020;156:746–753.
Garcovich S, Fania L, Caposiena D, Giovanardi G, Chiricozzi A, de Simone C, et al. Pediatric hidradenitis suppurativa: a cross‐sectional study on clinical features and treatment approaches. J Cutan Med Surg. 2022;26:127–134.
Wright S, Strunk A, Garg A. Trends in body mass index before and after diagnosis of hidradenitis suppurativa. Br J Dermatol. 2021;185:74–79.
Réka P, Janka EA, Soltész L, Szabó IL, Kapitány A, Dajnoki Z, et al. Chronic inflammatory intestinal disorders in hidradenitis suppurativa. Dermatology. 2023;239:592–600.
Lloyd‐McLennan AM, Ali S, Kittler NW. Prevalence of inflammatory bowel disease among pediatric patients with hidradenitis suppurativa and the potential role of screening with fecal calprotectin. Pediatr Dermatol. 2021;38:98–102.
Schwartz DA, Ghazi LJ, Regueiro M. Guidelines for medical treatment of Crohn's perianal fistulas: critical evaluation of therapeutic trials. Inflamm Bowel Dis. 2015;21:737–752.
McCurdy JD, Parlow S, Dawkins Y, Samji K, Rhee GG, Oliveira L, et al. Tumor necrosis factor inhibitors may have limited efficacy for complex perianal fistulas without luminal Crohn's disease. Dig Dis Sci. 2020;65:1784–1789.
McCurdy JD, Weng R, Parlow S, Dawkins YM, Brar G, Oliveira L, et al. Video capsule endoscopy can identify occult luminal Crohn's disease in patients with isolated perianal fistulas. J Crohns Colitis. 2023;17:1624–1630.
Rinawi F, Greer MC, Walters T, Church PC, Ricciuto A, Langer JC, et al. Anti TNF treatment of complex perianal fistulas in children without luminal Crohn's disease: is it an option? J Pediatr Surg. 2022;57:569–574.
Scharl M, Rogler G, Biedermann L. Fistulizing Crohn's disease. Clin Transl Gastroenterol. 2017;8:e106.
Orenstein LAV, Wright S, Strunk A, Garg A. Low prescription of tumor necrosis alpha inhibitors in hidradenitis suppurativa: a cross‐sectional analysis. J Am Acad Dermatol. 2021;84:1399–1401.
Morris MW, Stewart SA, Heisler C, Sandborn WJ, Loftus EV, Zello GA, et al. Biomarker‐based models outperform patient‐reported scores in predicting endoscopic inflammatory disease activity. Inflamm Bowel Dis. 2018;24:277–285.