What role should dermatologists take in screening for comorbidities in HS patients?
Clinical Applications
Dr. Schwarzenberger is the former physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, FAAD, August 1, 2022
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Amit Garg, MD, FAAD, from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, about his recent JAAD paper “Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the U.S. and Canadian Hidradenitis Suppurativa Foundations.”
DermWorld: American and Canadian researchers came together to publish recommendations for comorbidity screening in patients with hidradenitis suppurativa (HS). Can you tell us about your study and what you concluded?
DermWorld: What prompted this study?
Dr. Garg: Over the past several years, there has been an abundance of original studies describing a myriad of comorbid conditions linked to HS. There was a need to systematically evaluate the data on this topic, and summarize the level of evidence on comorbidity screenings, so that dermatologists and other physicians who are part of the care team have an evidence-based framework for comprehensively caring for the HS patient.
DermWorld: Were there any surprises in your findings?
Dr. Garg: Our review confirmed that HS has a high burden of comorbid disease, perhaps more so than any other skin disease.
DermWorld: You mentioned in the article that some of the screening may be out of scope for dermatologists. Can we explore this a bit and suggest what you believe the role we, as dermatologists, should take in getting this important screening accomplished?
Dr. Garg: There are some screenings with which dermatologists will be most experienced; that is, identification and management of comorbid conditions involving the integument, such as acne vulgaris or pyoderma gangrenosum. There are also systemic conditions for which dermatologists can screen by asking specific questions related to symptoms, and our guidelines document — published as open access in JAAD — specifies these. Then there are screenings for systemic conditions which involve examinations and laboratory testing with which dermatologists may be less familiar. However, even in these instances, the dermatologist can have a critical role in advocating for the patient’s health by ensuring they obtain a primary care physician and communicating the need for screening for at-risk conditions.
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DermWorld: While I realize this study did not by design address outcomes, per se, do we know if treating comorbidities might be expected to impact HS or vice versa?
Dr. Garg: We know that early identification and management of comorbid conditions, such as diabetes mellitus for example, is important in reducing morbidity and mortality. In fact, we’ve shown that HS patients with a high comorbidity burden have up to five times the risk of death compared to healthy patients. We don’t yet have evidence that aggressively controlling inflammation in HS also improves the status of selected comorbid conditions, or that managing comorbidities effectively controls disease activity in HS.
Dr. Garg is professor and the founding Chair for the Department of Dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. His paper appeared in JAAD.
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 Therapeutics, and Viela Biosciences, and receives honoraria. Dr. Garg receives research grants from AbbVie, UCB, and the National Psoriasis Foundation and is co-copyright holder of the HS-IGA and HiSQOL instruments.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
