Clinical and demographic characteristics of hydradenitis suppurativa patients who applied to Dicle University Medical Faculty Hospital Dermatology Polyclinic

Introduction and Aim: Hidradenitis suppurativa (HS) or acne inversa is a chronic, inflammatory, recurrent skin disease that affects hair follicules, characterized by painful, deeply located, inflammatory lesions that occur mostly after puberty. It is more common in areas of the body rich in apocrine glands, such as the axilla, inguinal and anogenital regions. The prevalence of HS varies between % 0.03-4 according to the populations. The Hurley classification is useful for assessing disease severity, but it has some limitations. HS has a significant morbidity and significantly affects patients physically, psychologically and socially. HS has the highest impact on patient's quality of life of all evaluated dermatological diseases. In recent years, studies on HS have been increasing and it has become one of the popular topics. There are few epidemiological studies on HS in Turkey. In our study, we evaluated the clinical and sociodemographic characteristics of patients diagnosed with HS and diagnosed with HS for the first time, who applied to the dermatologypoliclinic.In this way, we aimed to determine the characteristics of HS patients in and around Diyarbakır, to contribute to the epidemiological data in Turkey and to compare with the HS data of other countries. Materials and Methods:Fifty patients diagnosed with HS and diagnosed with HS for the first time, who applied to the Dicle University Medical Faculty Hospital Dermatology Department polyclinic between June 2021 and June 2022 were included in the study. Sociodemographic characteristics of the patients included in the study, such as gender, age, height, weight, body mass index, occupation, income level, marital status, educational status, family history, smoking, alcohol and substance abuse were recorded.Patient's complaints at admission, age at onset of HS, localization of HS, delay in diagnosis, severity of HS disease, accompanying systemic comorbidities, and treatment modalities were examined.The Hurley staging system was used in each patient to assess disease severity. All patients who met the diagnostic criteria for HS were included in the study. Results: %50 of patients were male and %50 were female and their mean age was 31.24 ± 9.818 years. The married female group comprised %30 of the patients (p = 0.046). The mean age of onset of HS was 22.52 years and men (26.84 years) were older than women (18.20 years) (p = 0.001). The mean delay time in the diagnosis of HS was 73.66 ± 78.83 months, and it was shorter in men (45.48 months) than in women (101.84 months) (p = 0.003). While the mean BMI was 28.936 ± 5.9343 kg/m2, %68 of the patients were in the overweight, obese and morbid obese categories. %72 of patients had a history of smoking. Smoking rate was higher for men (%96) than in women (%48). A family history of HS was found in %8 of the patients. In our study, the patient density was higher in moderate and severe Hurley stages (Hurley Stage II %48 and Stage III %32). The meanscore of affected areas was 3.66 ± 1.847 (min:1 max:7), with amean of 1.80 in Hurley stage I, 3.71 in II and 4.75 in III. The axillary region (%90) was most frequently affected, followed by the inguinal region (%70) and then the inter-breast area (%46).In men, axillary and atypical localization (scalp, face, neck, back) regions were significant, while in women, the location between and below the breasts was significant (p<0.05). Although the gluteal region and perianal region were affected more frequently in men and the inner thigh region in women, it was not significant (p>0.05). Acne conglobata was accompanied by %12, dissecting cellulitis in %8 and pilonidal sinus in %32, and follicular occlusion tetrad was detected in %6 of the patients. It was observed that %52 of patients had at least one comorbid disease. Comorbidities included diabetes %16, cardiovascular disease %6, psychiatric disorder %6, hypertension %4, and PCOS %4. Disease severity was associated with smoking history, location of axillary, inguinal and glutealregions, total score of affected areas and associated follicular occlusioncomponents (p <0.05). Among the topical treatments, clindamycin (%26) was preferred and among systemic treatments, rifampicin + clindamycin (%30), doxycycline (%28) and isotretinoin (%26) were preferred most frequently.Biological treatment agent was applied in 32% of the patients and adalimumab was preferred in all of them.Etanercept and secukinumab treatments were administered to two patients who did not respond to adalimumab treatment. Conclusion:There are limited number of studies on the clinical and sociodemographic characteristics of HS in our country. Our study provides detailed data on the epidemiology of HS for Diyarbakir and its surroundings. Although the density of patients is limited, it will also contribute to the epidemiology of HS in our country. The data we obtained, although it is similar to the data of our country and other countries, it's shows some differences. This suggests that genetic factors, ethnic factors, smoking and dietary habits may play a role in the etiopathogenesis of HS. Keywords: Epidemiology, Hidradenitis suppurativa, Hurley staging, Clinical features,Etiopathogenesis, Sociodemographic features