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• W3131022016 abstract "To the Editor: Although hidradenitis suppurativa (HS) has a mean age of onset at about 22 years, late-onset HS can occur.1Cazzaniga S. Pezzolo E. Bettoli V. et al.Characterization of hidradenitis suppurativa phenotypes: a multidimensional latent class analysis of the National Italian Registry IRHIS.J Invest Dermatol. 2020; https://doi.org/10.1016/j.jid.2020.08.032Abstract Full Text Full Text PDF Scopus (2) Google Scholar,2Naik H.B. Paul M. Cohen S.R. Alavi A. Suàrez-Fariñas M. Lowes M.A. Distribution of self-reported hidradenitis suppurativa age at onset.JAMA Dermatol. 2019; 155: 971-973Crossref PubMed Scopus (12) Google Scholar We analyzed data from 1100 consecutive, newly diagnosed patients with HS from 17 Italian outpatient clinics participating in the Italian Registry of HS (IRHIS).1Cazzaniga S. Pezzolo E. Bettoli V. et al.Characterization of hidradenitis suppurativa phenotypes: a multidimensional latent class analysis of the National Italian Registry IRHIS.J Invest Dermatol. 2020; https://doi.org/10.1016/j.jid.2020.08.032Abstract Full Text Full Text PDF Scopus (2) Google Scholar Our aim was to assess the existence of clusters in the HS distribution in terms of age at onset and to evaluate differences between clusters with respect to demographics, clinical characteristics, and HS phenotypes. A detailed description of the methods used is reported in the Supplementary Materials (available via Mendeley at https://data.mendeley.com/datasets/hstfswp5nv/1). In this analysis, we relied on both k-means and Gaussian mixture model (GMM) clustering algorithms. Both methods indicated that a two-cluster model was best fitted to our data (Fig 1, Supplemental Table I) with early-onset HS peaking in the late teen years (mean = 17.0 years) and late-onset HS peaking at around the age of 40 years (mean = 38.4 years), with an optimal separation threshold at 28 years. Both univariate and age-adjusted and sex-adjusted multivariable logistic regression analyses were performed (Table I).Table IDemographics and clinical characteristics of 1100 patients included in the study according to hidradenitis suppurativa onsetVariableEarly-onset HSLate-onset HSP value†Pearson's Χ2 test (or Fisher's exact test where required) and Mann-Whitney U tests were used in univariate analysis to compare nominal and continuous variables, respectively.Multivariable analysis‡Results from logistic regression models including age and sex as covariates.n∗Numbers may not add up to the total due to missing data. = 843%n∗Numbers may not add up to the total due to missing data. = 257%N∗Numbers may not add up to the total due to missing data.OR (95% CI)P valueSex Male32038.0%11042.8%.164301.41 Female52362.0%14757.2%6700.86 (0.61-1.23)Age (years) Mean, SD28.410.545.39.7<.00111001.14 (1.12-1.16)§OR per unit increase.<.001BMI (kg/m2) Mean, SD26.55.728.76.5<.00110801.02 (0.99-1.05)§OR per unit increase..10Education Elementary/lower secondary22326.5%8733.9%.023101 Upper secondary46655.3%11845.9%5840.76 (0.50-1.15).20 University15418.3%5220.2%2060.74 (0.45-1.23).25Smoker No28633.9%6424.9%<.0013501 Yes51761.3%15560.3%6720.61 (0.40-0.93).02 Ex404.7%3814.8%781.54 (0.79-3.01).20HS in first-degree relatives No57377.0%19189.7%<.0017641 Yes17123.0%2210.3%1930.31 (0.18-0.56)<.001Age at HS onset (years) Mean, SD17.04.638.48.7----HS duration since onset (years) Mean, SD11.49.87.06.7<.00111000.48 (0.37-0.62)ǁOR of log10 transformed data, representing OR per 10 units increase.¶Adjusted for sex only.<.001Diagnostic delay (years) Mean, SD7.68.44.24.9<.00111000.21 (0.16-0.28)ǁOR of log10 transformed data, representing OR per 10 units increase.<.001Hurley I30335.9%8733.9%.083901 II39947.3%11143.2%5101.05 (0.71-1.56).81 III14116.7%5923.0%2000.70 (0.43-1.16).17Sartorius score Mean, SD55.150.160.461.6.8010350.42 (0.25-0.69)ǁOR of log10 transformed data, representing OR per 10 units increase..001DLQI Mean, SD12.97.814.38.4.047391.01 (0.99-1.04).30Localization#Multiple localizations/comorbidities were possible. Neck505.9%62.3%.0211000.27 (0.10-0.74).01 Mammary18922.4%4116.0%.030.51 (0.31-0.82).006 Axillae53663.6%14556.4%.040.79 (0.55-1.13).20 Buttocks25830.6%8733.9%.330.85 (0.58-1.24).40 Groin59170.1%17869.3%.800.79 (0.54-1.16).22 Anogenital area769.0%3714.4%.010.76 (0.45-1.28).31 Other15117.9%4216.3%.561.04 (0.65-1.64).88HS-related characteristics and comorbidities#Multiple localizations/comorbidities were possible. Acne conglobata8910.6%238.9%.4511000.63 (0.34-1.18).15 Pilonidal cyst10912.9%135.1%<.0010.40 (0.20-0.77).007 Folliculitis decalvans91.1%20.8%10.62 (0.10-3.69).60 Other forms of acne374.4%62.3%.140.80 (0.28-2.31).68 DermatitisIncluding atopic, seborrheic, and perioral dermatitis.60.7%51.9%.145.46 (1.15-25.81).03 Psoriasis111.3%93.5%.032.45 (0.85-7.09).10 Diabetes20.2%31.2%.090.72 (0.09-5.92).76 Thyroid disease111.3%41.6%.761.23 (0.30-5.05).77 Crohn disease80.9%31.2%.720.47 (0.10-2.14).33BMI, Body mass index; CI, confidence interval; DLQI, dermatology life quality index; HS, hidradenitis suppurativa; n, number of patients in each group; N, total number of patients included in multivariable analysis; OR, odds ratio; SD, standard deviation.∗ Numbers may not add up to the total due to missing data.† Pearson's Χ2 test (or Fisher's exact test where required) and Mann-Whitney U tests were used in univariate analysis to compare nominal and continuous variables, respectively.‡ Results from logistic regression models including age and sex as covariates.§ OR per unit increase.ǁ OR of log10 transformed data, representing OR per 10 units increase.¶ Adjusted for sex only.# Multiple localizations/comorbidities were possible.∗∗ Including atopic, seborrheic, and perioral dermatitis. Open table in a new tab BMI, Body mass index; CI, confidence interval; DLQI, dermatology life quality index; HS, hidradenitis suppurativa; n, number of patients in each group; N, total number of patients included in multivariable analysis; OR, odds ratio; SD, standard deviation. Patients were found to be similarly overweight in both early-onset and late-onset groups, with no sex differences found after adjusting for confounding variables. A significantly lower proportion of patients in the late-onset group were smokers (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.40-0.93) and had a reported history of HS in first-degree relatives (OR, 0.31; 95% CI, 0.18-0.56). In addition, a shorter mean diagnostic delay and illness duration since the onset were observed in late-onset patients. Moreover, a less severe disease (according to the Sartorius score) was documented in the late-onset group compared with the early-onset group (OR, 0.42; 95% CI, 0.25-0.69). The frequency of involvement of the axillary-groin-buttocks and anogenital areas was similar between the 2 groups, whereas the neck and mammary locations were significantly and more frequently reported in the early-onset group (P < .05). Similarly, follicular lesions, such as pilonidal cysts, were more frequently associated with early-onset HS (OR, 0.40; 95% CI, 0.20-0.77). Among additional HS-related features and comorbidities, atopic, seborrheic, and perioral dermatitis were all significantly associated with late-onset HS (OR, 5.46; 95% CI, 1.15-25.81). Limitations of our analyses are the inclusion of tertiary care outpatient HS cases, the potential recall bias of self-reported age at onset, the absence of a formal validation on an independent dataset in order to test cluster stability, and the possibility of having residual confounding variables concerning the effect of age on the observed associations. Nevertheless, our analyses relied on a robust method for stratifying patients, and we were able to confirm the possibility of a late-onset HS variety in Italian patients in agreement with observations from another single study from North America.2Naik H.B. Paul M. Cohen S.R. Alavi A. Suàrez-Fariñas M. Lowes M.A. Distribution of self-reported hidradenitis suppurativa age at onset.JAMA Dermatol. 2019; 155: 971-973Crossref PubMed Scopus (12) Google Scholar,3Jung Y.G. Kang M.S. Heo J. Clustering performance comparison using K-means and expectation maximization algorithms.Biotechnol Biotechnol Equip. 2014; 28: S44-S48Crossref PubMed Scopus (60) Google Scholar The correlation between early-onset HS and a stronger familial history was previously reported in another retrospective study.4Deckers I.E. van der Zee H.H. Boer J. Prens E.P. Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement.J Am Acad Dermatol. 2015; 72: 485-488Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar Distinct late-onset phenotypes have been reported in Crohn's disease, a chronic inflammatory condition sharing clinical and pathogenetic characteristics with HS. An age of onset of Crohn's disease after 60-65 years has been associated with stenosing disease, increased comorbidities, and medication burden.5Viola A. Monterubbianesi R. Scalisi G. et al.Late-onset Crohn's disease: a comparison of disease behaviour and therapy with younger adult patients: the Italian Group for the Study of Inflammatory Bowel Disease ‘AGED’ study.Eur J Gastroenterol Hepatol. 2019; 31: 1361-1369Crossref PubMed Scopus (5) Google Scholar The natural history and disease course in older adults with HS are unknown. Fixed-age cut-offs for the definition of early-onset and late-onset disease may prove challenging for clinical studies because of the skewed age distributions found in patients with HS. Cluster analysis may prove to be a useful strategy for addressing this issue and better defining the trajectories of comorbid conditions in HS. Future investigations assessing the significance of our phenotypes and outcomes in late-onset HS in terms of disease characteristics, prognostic factors, and treatments are recommended. None disclosed." @default.
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• W3131022016 title "Late-onset hidradenitis suppurativa: A cluster analysis of the National Italian Registry IRHIS" @default.
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