Overall and subgroup prevalence of pyoderma gangrenosum among patients with hidradenitis suppurativa: A population-based analysis in the United States

J Am Acad Dermatol. 2019 Jun;80(6):1533-1537. doi: 10.1016/j.jaad.2019.02.004. Epub 2019 Feb 7.


Background: Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are reported to coexist, although the prevalence of PG among patients with HS has not been systematically evaluated.

Objective: To evaluate PG prevalence among patients with HS.

Methods: Cross-sectional analysis of adults with PG among patients with HS and patients without HS through use of electronic health records data from a population-based sample of 55 million patients.

Results: The prevalence of PG among 68,232 patients with HS was 0.18% (125 of 68,232), compared with 0.01% (1835 of 31,435,166) among those without HS (P < .0001). Prevalence was markedly higher among patients with HS and Crohn's disease (CD) (3.68%) than among patients with HS but without CD (0.12%). The odds of having PG were 21.14 (95% confidence interval [CI], 17.51-25.51) times greater among patients with HS than among those without HS. Patients with HS with CD had 12.38 (95% CI, 9.15-16.74) times the odds of having PG than did patients without HS but with CD. Among patients without CD, compared with patients without HS, those with HS had 26.51 (95% CI, 21.07-33.36) times the odds of having PG.

Limitations: We could not establish HS phenotype among those having coexistent PG, nor could we distinguish syndromic from nonsyndromic cases.

Conclusion: Patients with HS have an increased prevalence of PG, regardless of CD status. Painful ulcerations among patients with HS warrant additional evaluation for PG.

Keywords: Crohn's disease; Explorys; PADH; PAPASH; PASS; acne; ankylosing spondylitis; conglobata; hidradenitis suppurativa; pyoderma gangrenosum; pyogenic arthritis.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Hidradenitis Suppurativa / epidemiology*
  • Humans
  • Middle Aged
  • Prevalence
  • Pyoderma Gangrenosum / epidemiology
  • Skin Ulcer / epidemiology
  • United States / epidemiology
  • Young Adult