Sub-classification of Hidradenitis suppurativa: a cross-sectional study
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Sub‑classification of Hidradenitis suppurativa: a cross‑sectional study Linnea Thorlacius1,2 · Peter T. Riis1 · Emil Knudsen List1 · Robin Christensen2,3 · Gregor B. E. Jemec1 Received: 28 April 2020 / Revised: 13 August 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The typical Hidradenitis Suppurativa (HS) patient is a young woman with axillary and groin involvement, but the spectrum of the disease presentation is broad and no internationally acknowledged sub-classification of the disease exists to date. It is however speculated that different, yet unidentified, subtypes may respond differently to different treatments or carry a different prognosis. Classification according to self-reported clinically meaningful outcomes for patients offer practical advantages. Our objective was to build an empirical framework for sub-classification of HS patients based on the frequency of HS flares in various anatomic locations, using a cross-sectional questionnaire-based design. All patients with a clinically confirmed diagnosis of HS registered at our department until March 1, 2017 were invited to participate. The frequency of HS flares in various anatomic locations was used for identification of possible HS subtypes using Principal Component Analysis (PCA) and cluster analysis. A total of 524 (62%) of 845 invited patients answered the questionnaire; 402 (76.7%) were female. From the cluster analysis, we identified two possible subtypes of HS, labeled the “upper type” and the “lower type”. The “upper type” was characterized by repeated outbreaks in axillary and mammary regions. Meanwhile, the “lower type” was characterized by outbreaks in the inguinal, genital, perianal, and gluteal regions. Our findings support the notion that HS can be sub-classified and imply that the pattern of where lesions are located may be an important element in future HS sub-classification systems. Keywords Hidradenitis suppurativa · Sub-classification · Phenotyping · Cluster analysis
Introduction Hidradenitis suppurativa (HS) is defined clinically by lesions, location and history. The primary lesions (nodules) progress from a non-inflamed to inflamed and may further develop into abscesses and sinus tracts (tunnels). Lesions
The Department of Dermatology at Zealand University Hospital is part of the European Reference Network for skin diseases (ERNSKIN). * Linnea Thorlacius [email protected] 1
Department of Dermatology, Roskilde; Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark
2
Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
3
Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
must be localized in the axillae, groin, peri-genital or perianal skin and must have a chronic (> 3 months) or recurrent (> 2 flares/6 months) history [1, 2
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