HS in Elderly Patients Possibly Associated With Male Sex, Study Suggests

The prevalence of hidradenitis suppurativa (HS) in the elderly is not uncommon, and a movement from female predominance toward a lower female-to-male ratio in HS was seen, possibly indicating an association with male sex, according to study findings published in the British Journal of Dermatology.

HS in the elderly showed significant variation in age of onset and involved body areas, and elderly HS patients were more susceptible to multimorbidity. The researchers also proposed defining HS in elderly as “HS tarda” and subdividing it into late-onset and persistent HS tarda.

Older man walking with companion

First, the researchers proposed the name HS tarda for HS presenting in the elderly population, and researchers suggested the subdivision of HS tarda into patients in different groups: those who develop their first symptoms before age 60 (the persistent HS tarda group) and patients who develop first symptoms after 60 years of age (the late-onset HS tarda group).

HS is a chronic, overwhelming multifactorial skin disease. Patients usually develop HS following puberty and the prevalence of the disease is expected to decrease as age increases. Data outside the usual age range are limited, especially for those who are elderly.

Then, researchers aimed to evaluate the prevalence, clinical characteristics, and associated comorbidities among the elderly population with HS.

Even though knowledge of HS in childhood is growing, data about HS in older adults are scarce. Because the worldwide population is aging, with the population of those older than 65 expected to reach 2 billion people by 2050, physicians might start encountering the elderly population with HS.

Data were obtained through a population-wide survey-based study within the Lifelines Cohort Study in the Netherlands. The clinical characteristics of elderly patients with HS (≤60 years) were compared with those of an adult (<60 years) HS population.

To compare comorbidities, elderly patients with HS were compared with a sex- and age-matched elderly population without HS in a 1:4 ratio. HS in elderly was defined as active HS in patients 60 years and older. Within this group, 2 subgroups were defined as late-onset HS (HS developed after age 60 years) and persistent HS (HS developed at younger age but continued after 60 years).

In the Lifelines cohort, 209 elderly patients with HS were identified, as well as an adult (< 60 years) HS group (n = 793) and a non-HS sex- and age-matched control elderly group (n = 810). The elderly population’s prevalence of HS was 0.8% (95% CI, 0.4%-1.2%). A significantly higher age of HS symptom onset was found (40.0 years) compared with the adult HS group (23.0 years) (odds ratio, 1.056; 95% CI, 1.05-1.07). A female:male ratio of 1.7:1.0 and a higher family history of HS were discovered among the elderly HS cohort. Additionally, elderly HS patients had a significantly higher risk of having HS-linked comorbidities compared with the sex-and age-matched controls.

Their study findings suggest that HS tarda might be associated with male sex. HS in the general population seems to be significantly more common for female patients. The shift in the female-to-male ratio in HS tarda might be because of the influence of the menopause the progression of HS in women, the authors suggested.

Because multimorbidity is strongly linked with frailty, they recommended efforts to decrease the multimorbidity risks and encourage multidisciplinary collaboration with general practitioners and their patients. Male sex, a higher age of onset, and a positive family history for HS are major predictive risk factors, they noted.

This study had some limitations. The study was retrospective and some variables consisted of incomplete data. It was also limited by the self-reported HS diagnosis even though an effort was made to minimize the chance of false positive cases.

“This study highlights the need for more, larger-scale and prospective studies to investigate potentially understudied clinical characteristics and comorbidities in elderly HS patients,” emphasized the authors.

This is the first study that uncovered the prevalence of HS in an elderly population, and to the researchers’ knowledge, the largest study defining the clinical characteristics and comorbidities of this population.

“Our findings provide new insights into the clinical characteristics and epidemiology concerning HS in elderly, and can contribute to new steps in diagnostic approaches and clinical management of this specific and fragile population,” concluded the researchers.

Reference

van der Weijden DAY, Koerts NDK, van Munster BC, van der Zee HH, Horváth B. Hidradenitis suppurativa tarda: defining an understudied elderly population. Br J Dermatol. Published online September 4, 2023. doi:10.1093/bjd/ljad317