Diagnostic Delay in Hidradenitis Suppurativa: Still an Unsolved Problem

Abstract

<b><i>Introduction:</i></b> 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. <b><i>Method:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.