Impact of Dermatology Consult on Inpatient and Acute Care Management of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a debilitating condition that remains challenging to manage, at times prompting presentation to the hospital. Indeed, HS has proven to be a disproportionate and increasing driver of the utilisation of emergency and inpatient care when compared to other dermatologic conditions, with readmission rates comparable to patients with heart failure [1, 2]. While there are guidelines in place for the management of HS in acute care settings, little is known about the role that dermatology consultations may play [3, 4]. Previous studies have consistently highlighted the important contribution of dermatology consults in enhancing inpatient care for a variety of dermatologic conditions [5, 6]. To that end, we aimed to evaluate the role of dermatology consultation in the management of HS in the acute care hospital setting. Using the Mass General Brigham Research Patient Data Registry, patient encounters wherein HS was the principal diagnosis were identified across nine hospital sites from December 2019 to December 2023. Manual chart review was conducted to ensure a pre-existing diagnosis of HS was the primary reason for the encounter, obtain dermatology consultation status, primary team diagnosis and management plan, dermatology team diagnosis and management plan, and discharge planning details including dermatology follow-up. In total, 259 encounters across 198 unique patients were identified, including 212 emergency room visits and 47 inpatient admissions (Table 1). Of these encounters, only 60 (23.2%) included a dermatology consultation. The likelihood of receiving a dermatology consult did not vary based on patient characteristics, including age, sex at birth, race, ethnicity, or insurance type. Disease severity could not be assessed given variability in chart documentation and lack of standardisation. In terms of care outcomes, follow-up care with dermatology was significantly higher following encounters that included a consult; 59 (98.3%) received a follow-up appointment compared to 61 (30.7%) in the nonconsult group. A change in management was recommended by the dermatology consultant in 54 (90%) consult encounters, with adjustments in antibiotic regimens, steroid regimens, and supportive care representing the majority of plan adjustments (Table 2). Notably, new biologic agents were introduced in seven cases (12.9%). Limitations to the study centre on its retrospective design, single-centre sample, and reliance on medical record review, as well as its reliance on varying documentation limiting the ability to classify HS disease severity. Additionally, it should be noted that while our study did demonstrate utility of dermatology consultation in management of known HS, we did not evaluate whether dermatology consultation conferred shortened time to initial diagnosis. Improving early detection of HS remains a key challenge in dermatology. In summary, we found that dermatology consultations in inpatient and emergency care settings may play an important role in optimising care for certain patients with HS, modifying HS management at a rate comparable to or slightly higher than findings in other general inpatient dermatology studies [7]. Mechanisms contributing to improved patient follow-up could include utilization of established referral pathways, increased patient engagement with dermatology, and subsequent adherence to follow-up care and adjustments to management strategy [8]. Future studies should evaluate if dermatology consultation and subsequent changes in management reduce length of stay, reduce readmission rates, and aid controlling overall disease activity. There is also likely a role for piloting pathways in the emergency room setting to bridge acute and chronic management of HS, evaluating cost effectiveness of dermatology consultation for HS, as well as validating these findings in larger patient populations across the United States. Natalie Baker: project administration, formal analysis, and writing – review and editing. Baraa Hijaz: data curation, formal analysis, and writing – original draft. Allison Holt, Joseph Ebriani, and Bethany J. Brumbaugh: data curation and writing – review and editing. Michael Stephens, John Trinidad, Arash Mostaghimi, and Daniela Kroshinsky: supervision and writing – review and editing. Steven T. Chen: supervision and writing – review and editing. The authors received no specific funding for this work. Reviewed and approved by Mass General Brigham IRB; approval #2023P002034. Steven T. Chen has received honoraria from Pfizer, and is on the Board of Directors of the Medical Dermatology Society. Arash Mostaghimi has grants from the National Alopecia Areata Foundation, Pfizer, and received royalties/licences from BETA/BELA/ALFA Tools, and has consulted for Hims and Hers, AbbVie, Sun Pharmaceuticals, Pfizer, Digital Diagnostics, Lilly, Equillium, ASLAN, Boehringer Ingelheim, ACOM, Olaplex, Legacy Healthcare, and Pelage; he is president elect of medical dermatology society. N.M.B is on the board/executive committees of Healthcare without Harm, the Medical Society Consortium on Climate and Health, Medical Students for a Sustainable Future, has received travel funding from Brigham and Women's Hospital, and is outgoing vice chair of the Massachusetts Medical Society Committee on Environmental and Occupational Health. The remaining authors declare no conflicts of interest. While the data are not publicly available due to patient privacy concerns, a reasonable request for the data can be made to the corresponding author.