A cross-sectional patient survey in a tertiary hidradenitis suppurativa clinic

Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects approximately 0.8% of the UK population. A survey was carried out among patients attending a tertiary HS clinic with the aim of better understanding the management of HS in primary care, and identifying the prevalence of associated risk factors. A total of 212 of the 552 patients (38.4%) invited chose to participate. The length of time patients had experienced symptoms before consulting their general practitioner (GP) was variable with 33.8% (n = 63) of participants reporting symptoms for 3–10 years and 26.3% (n = 49) experiencing symptoms for > 10 years. The majority of patients were given a diagnosis in secondary care (n = 103; 55.4%) and 28.5% (n = 53) by their GP. In primary care, treatments prescribed included topical treatment and antimicrobial washes (n = 107; 65.2%). Just over half (n = 84; 51.2%) were prescribed short and extended courses of antibiotics. Looking at lifestyle factors, 31.5% (n = 52) were current and 27.9% ex-smokers (n = 46). The majority (n = 108; 65.5%) identified themselves as being overweight, with 67.8% (n = 112) wanting to lose weight. Almost a third of patients (n = 107; 64.5%) did not carry out exercise regularly (defined as cardiovascular exercise three times weekly). Eighty per cent (n = 132) of patients reported that they had not received any psychological support for HS, either from primary or from secondary care. This study highlights that only a small proportion of patients with HS were diagnosed by their GP, with the majority receiving a diagnosis from their secondary care physician. A self-reported lack of confidence by GPs in diagnosing HS has historically been highlighted. Despite this lack of confidence, this study demonstrates good adherence to existing UK recommendations for the initial treatment of HS when the diagnosis is made. The negative effects of lifestyle factors on HS, such as smoking and obesity, are well recognized. Despite this, over half of patients in this study who were current smokers had not been offered referral to a smoking cessation service. This study underscores the need to screen for depression and anxiety in patients with HS and improve access to psychology services. This patient self-reported study gives an insight into the importance of providing holistic care for patients with HS. As GPs gain confidence in the diagnosis and initial management of HS, an awareness of associated lifestyle changes and comorbidities can further enhance the holistic care of patients with HS in primary care.