Diagnostic delay in hidradenitis suppurativa is a global problem
July 21, 2015
D.M. Saunte, J. Boer, A. Stratigos, J.C. Szepietowski, I. Hamzavi, K.H. Kim, K. Zarchi, C. Antoniou, L. Matusiak, H.W. Lim, M. Williams, H.H. Kwon, M.A. Gürer, F. Mammadova, A. Kaminsky, E. Prens, H.H. van der Zee, V. Bettoli, S. Zauli, J. Hafner, S. Lauchli, L.E. French, H. Riad, M. El-Domyati, H. Abdel-Wahab, B. Kirby, G. Kelly, P. Calderon, V. del Marmol, F. Benhadou, J. Revuz, C.C. Zouboulis, I. Karagiannidis, K. Sartorius, L. Hagströmer, E. McMeniman, N. Ong, M. Dolenc-Voljc, Z.B. Mokos, L. Borradori, R.E. Hunger, C. Sladden, N. Scheinfeld, N. Moftah, L. Emtestam, J. Lapins, N. Doss, I. Kurokawa, G.B.E. Jemec
British Journal of Dermatology, 173, 1546–1549, December 2015
Hidradenitis suppurativa (HS) is a chronic, recurrent and painful disease in which there is inflammation in areas of the apocrine sweat glands. These glands are found mainly in the armpits and groins. Within HS there may be a blockage of the hair follicles. This causes a mixture of boil-like lumps, areas leaking pus, and scarring. Figures regarding how many people have HS vary greatly, from 0·0003% to 4% of the population. Evidence suggests that not all patients seek medical help and there is a significant delay between symptoms starting and diagnosis. In this study, 517 patients with HS and 516 patients with another skin disease, psoriasis, from 24 countries were asked about the time it took to first see a doctor and then receive a diagnosis. The average patient delay in seeing a physician, i.e. the mean time from the onset of symptoms to the first visit with any physician, was 2·3 years for HS patients and 1·0 year for psoriasis patients. The diagnostic delay was 7·2 years in HS and 1·6 years in psoriasis. In the HS group, 73·3% reported a significant diagnostic delay (more than 2 years), compared to 26·7% of psoriasis patients. In the HS group, women and patients with moderate and severe disease were more likely to experience a significant delay. In contrast, psoriasis patients with severe disease appeared to have a reduced likelihood of significant diagnostic delay. This delay may be caused by patient delay in consulting a physician, the consulted physician not making the correct diagnosis, or both. Surprisingly, a family history was associated with a longer delay for both diseases. This may indicate a higher threshold for seeking assistance or that the disease is seen as a ‘condition of life’ in some families. The authors conclude that this study emphasizes the need for education of patients as well as health care workers in order to make an accurate and early diagnosis, initiate treatment, prevent and reduce the number of days lost through sickness and to reduce healthcare expenses.