Hidradenitis Suppurativa in General Practice: A Pilot Study

Background: Hidradenitis suppurativa (HS) is a chronic debilitating skin disease with a diagnostic delay of 7 years. The general practitioner (GP) is often the first physician consulted by the HS patients, and often provide the initial treatment. Early diagnosis by GP is of major importance and may help to better control the course of the disease. Aim: To describe GP’s recognition and management of HS. Methods: GPs in Belgium and Denmark were invited to complete a questionnaire constructed to describe general knowledge about HS. Results: 103 Belgian and 51 Danish participated. Demographic characteristics were similar in both groups. Danish GPs estimated the disease to be more common. 0%/21.6% Belgian/Danish GPs seeing more than 20 patients with HS per week and conversely 28.2%/3.9% seeing no patients with HS per week. Belgian GPs were less likely to consider HS a chronic disease than the Danish GPs (41.7%/84.3%), and antibiotics were more commonly associated with HS by Danish GPs (31.4% versus 3.9%). Interestingly, Belgian and Danish GPs consider HS as an inflammatory (respectively 44.7% /58.8%) but also as an infectious disease (respectively 62.1%/ 64.7%). Conclusions: The early diagnosis and a correct management is a crucial step to improve the prognosis of the disease. This pilot study has attempted to assess the general knowledge about HS of Belgian and Danish GPs. Important differences have appeared, suggesting a need for more information to facilitate the management of the patients. A multidisciplinary approach is suggested for the management of this often debilitating disease. Our pilot study evaluates for the first time the knowledge of GPs about Hidradenitis Suppurativa. Unfortunately the disease is often misdiagnosed and we have reported a mean diagnosis delay of 7 years. An early diagnosis by GPs could greatly improve the course and the management of the disease. Introduction Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating follicular skin disease that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal and anogenital region (Dessau definition, first International Conference on Hidradenitis suppurativa, March 30-April 1, 2006, Dessau, Germany). The inflammatory nodules can progress to abscesses and mucopurulent discharge, with hypertrophic scarring and sinus tract formation in the late stages of the disease. HS is often associated with an impaired quality of life [1,2]. HS is histologically characterized by chronic follicular hyperkeratosis and its pathophysiology is not yet fully understood, but it likely includes an interaction between a complex genetic background and the effect of external factors [3]. HS has been considered to be a rare disorder but European studies based on population samples using validated questionnaires have suggested a prevalence of 1%-2% in the general population and a peak prevalence of 4% (including mild cases) among young adults [4-8]. In the United States, registry studies have suggested a much lower rate of 0.05 to 0%, 13% [9,10]. Several factors can play a role in these apparently diverging estimates of the prevalence rate. Different methodological approaches to the epidemiology undoubtedly play a role, but it may also be speculated that a lack of recognition of HS in the medical community, and reluctance by patients to present their stigmatizing disease for treatment play a role [11,12]. Little is known about the level of recognition of HS in the medical community. The present orphan status of the disease suggests that it is treated by many specialities, often with widely varying understanding of the diseases pathogenesis. The diagnosis of HS does not require any test and is primarily made on the basis of its typical clinical presentation and has to fit with the criteria adopted by the 2nd International Conference on Hidradenitis suppurativa in San Francisco [13] (Table 1). Journal of General Practice Benhadou, et al., J Gen Pract (Los Angel) 2015, 3:4 DOI: 10.4172/2329-9126.1000207 Short communication OMICS International J Gen Pract (Los Angel), an open access journal #123321 Volume 3 • Issue 4 • 10.4172/2329-9126.1000207 (1) Typical lesions, i.e., deep-seated painful nodules: ‘blind boils’ in early lesions; abscesses, draining sinus, bridged scars and ‘tombstone’ double-ended pseudocomedones in secondary lesions (2) Typical topography, i.e., axillae, groins, perineal and perianal region, buttocks, infra and inter mammary folds (3) Chronicity and recurrences All three criteria must be met for establishing the diagnosis Table 1: Diagnostic criteria of hidradenitis suppurativa (adopted by the 2nd International Conference on Hidradenitis suppurativa, March 5, 2009, San Francisco, CA US) The diagnosis has to be discussed when the recurrence of the lesions is more than 2 times/6 months [3]. The general practitioner (GP) is often the first physician consulted by the HS patients, and often provides the initial treatment. Only if initial treatment is not effective will the patients be referred for specialist treatment. Early diagnosis is of major importance and close collaboration between the GP and the specialists can lead to effective control and prevention of advanced disease. The diagnosis of the disease is often delayed. Globally there appears to be an average delay of 7 years from onset of symptoms to diagnosis. It is speculated that a lack of recognition of the lesions by the physicians may play a role in this [11]. The aim of this study was therefore to evaluate the general awareness of HS among the GPs and comparing the awareness of the Belgian and Danish GPs. Material and methods GPs in Belgium and Denmark were invited to complete a 13 item questionnaire constructed to describe general knowledge about HS (diagnosis, pathophysiology, prevalence, and management). For each question, multiple options were given and the respondent had to choose the most suitable answer(s) according to his/her perception (Table 2). Question 1 Sex : F / M Question 2 Year of birth Question 3 Year of end of medical studies Question 4 Since how long are you working? Question 5 How many patients do you have per week? Question 6 Mrs S., 49 years old has chronic abscesses since 10 years in the right and left axilla .The lesions are painful and suppurative.The lesions constituted with the years hypertrophic scars.Since 1 year, the patient has developed the same lesions in the groins.