Diagnostic Delay in Hidradenitis Suppurativa: Still an Unsolved Problem

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a diagnostic delay of 7-10 years. A later diagnosis is associated with development of local sequelae and systemic comorbidities, as well as a reduced response to medical treatment. The aim of this study was to analyze the time required for HS diagnosis and investigate factors associated with diagnostic delay.

A retrospective observational study was conducted based on clinical records from HS patients followed at a tertiary hospital, with diagnosis between January 2006 and December 2022.

A total of 285 patients were included. The mean diagnostic delay was 10.1 years, and there was no difference in time to diagnosis during the considered period. A diagnostic delay of more than 5 years was significantly associated with an earlier onset of symptoms, location on breasts and thighs, follicular phenotype, and with cardiovascular and psychiatric comorbidities. Smoking and body mass index ≥25 kg/m² were also associated with a longer diagnostic delay. A personal history of acne and a greater disease severity were associated with an earlier diagnosis.

This study reveals the lack of improvement in the diagnostic delay in HS and highlights its association with atypical clinical manifestations and systemic comorbidities, scarcely reported in literature.