Screening for HS Comorbidities

Dr. Ted Rosen reviews a comprehensive new paper that makes recommendations for screening for comorbidities in hidradenitis suppurativa (HS), with commentary from lead author Dr. Amit Garg on putting this into practice. 

By Ted Rosen, MD

“There are many comorbid conditions associated with hidradenitis. The dermatologist should screen for those which fall into the cutaneous domain and suggest more thorough screening be done by other health care professionals where appropriate. Recommendations in this comprehensive article were based on systematic review and meta-analysis of available published data,”¹ said Ted Rosen, MD, FAAD.

Dermatologists should screen for other folliculocentric disorders, such as acne vulgaris/conglobata, dissecting cellulitis of the scalp, and pilonidal disease. They also should screen for pyoderma gangrenosum, regardless of the presence or absence of inflammatory bowel disease.

“Dermatologists should remain alert for signs of psychiatric distress and screen for depression, generalized anxiety, and suicidal ideation, and ultimately refer to mental health professionals for management. The risk of suicide may be higher among female HS patients,” said Dr. Rosen.

High risks for tobacco and substance abuse exist and should be considered; opioid abuse may be associated with extreme levels of pain, according to Dr. Rosen.

“The metabolic syndrome, as an entity and each of its components, should be screened for; this includes diabetes, hypertension, dyslipidemia, obesity, and cardiovascular disease. Obesity should be noted and weight control should be part of the overall treatment plan, regardless of who precisely manages this.”

Other disorders for which the dermatologist may consider screening include sexual dysfunction, inflammatory bowel disease, and spondyloarthritis, according to Dr. Rosen.

“For the following diseases, there is simply insufficient evidence or too limited an association magnitude to warrant the dermatologist screening, according to the authors: thyroid disease, obstructive sleep apnea and other sleep disturbances, renal disease, Alzheimer disease, lymphoma, and psoriasis.”

Patients do not require comorbidity screenings at every visit, according to Amit Garg, MD.

“I try and complete one scope of practice screening whenever I can fit it into a visit, and I am able to achieve the pertinent screenings over the course of year or two. I also inform patients on which comorbidity screenings should be taken up by their primary care physician (PCP). So together with the PCP, the patient is likely to have their comprehensive care needs addressed.”

Dermatologists should screen for comorbid conditions involving the skin, said Dr. Garg.

“Dermatologists should be able to offer simple review of systems assessment to screen for co- morbidities involving other organ systems. If there is one common comorbid condition that also presents a significant risk to HS patients, it’s depression.”

“There is a simple 2-question depression screening which dermatologists can offer to patients. The open access guidelines article in the JAAD has a summary table which describes the pertinent screenings and the role of the dermatologist,” said Dr. Garg.

Editor’s Note: Dr. Garg’s paper in JAAD refers to the PHQ-2 and PHQ-9 screening instruments for depression.²

References:

1. Garg A, Malviya N, Strunk A, etal. Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86(5):1092-1101. doi:10.1016/j. jaad.2021.01.059.
2. Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. Br J Gen Pract. 2007;57(535):144-151.

Disclosures: Dr. Garg is an advisor for AbbVie, Aclaris Therapeutics, Anaptys Bio, Aristea Therapeutics, Boehringer Ingelheim, Bristol Myers Squibb, Incyte, InflaRx, Insmed, Janssen, Novartis, Pfizer, UCB, Union Thera- peutics, and Viela Biosciences, and receives honoraria. He receives research grants from AbbVie, UCB and National Psoriasis Foundation. He is co-copyright holder of the HS-IGA and HiSQOL instruments. Dr. Rosen reports no relevant disclosures.