Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations

J Am Acad Dermatol. 2022 May;86(5):1092-1101. doi: 10.1016/j.jaad.2021.01.059. Epub 2021 Jan 23.


Background: Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.

Objective: To provide evidence-based screening recommendations for comorbidities linked to HS.

Methods: Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.

Results: Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.

Limitations: Screening recommendations represent one component of a comprehensive care strategy.

Conclusions: Dermatologists should support screening efforts to identify comorbid conditions in HS.

Keywords: Crohn's disease; North America; acne; cardiovascular disease; comorbidity; depression; dermatologist; diabetes mellitus; dissecting cellulitis of the scalp; down syndrome; dyslipidemia; generalized anxiety disorder; guidelines; herpes zoster; hidradenitis suppurativa; hypertension; inflammatory bowel disease; lymphoma; metabolic syndrome; obesity; pilonidal disease; polycystic ovary syndrome; pyoderma gangrenosum; screening; sexual dysfunction; smoking; spondyloarthritis; substance use; suicide; systemic; ulcerative colitis.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Canada / epidemiology
  • Comorbidity
  • Female
  • Hidradenitis Suppurativa* / diagnosis
  • Hidradenitis Suppurativa* / epidemiology
  • Hidradenitis Suppurativa* / etiology
  • Humans
  • Metabolic Syndrome* / epidemiology
  • Pyoderma Gangrenosum* / epidemiology