Acute Myeloid Leukemia patients with comorbid hidradenitis suppurativa maintain stable disease during induction therapy–induced neutropenia: A single-center retrospective study

Abstract Background: Induction therapy for acute myeloid leukemia (AML) is associated with profound neutropenia, which can predispose patients to infectious complications and delayed tissue healing. While such immunosuppression is often assumed to worsen pre-existing inflammatory skin disorders, the impact on hidradenitis suppurativa (HS) in AML patients has not been well characterized. Understanding this relationship may help guide supportive care strategies and avoid unnecessary escalation of HS-directed therapy during intensive leukemia treatment. Methods: We conducted a retrospective review of adult AML patients admitted for induction therapy at a community hospital from January 2010 to December 2024 with a documented pre-existing diagnosis of HS. HS activity during hospitalization was assessed through dermatology and infectious disease consult notes, nursing wound documentation, and available photographs, classified by Hurley stage and lesion counts. Neutropenia was defined according to standard hematologic criteria and confirmed via daily complete blood counts. The primary outcome was change in HS burden during the neutropenic period. Secondary outcomes included incidence of HS flares, initiation of HS-directed systemic antibiotics, wound-healing delays, and HS-related infections. Results: Of 128 AML patients receiving induction therapy, 11 (8.6%) had documented pre-existing HS (median age 65 years [IQR 59–71]; 64% female; median HS duration 14 years [IQR 10–19]). HS lesion counts remained stable in 10 patients (91%) and decreased in 1 (9%); no patient had increased disease burden or progression in Hurley stage. Median lesion count at admission was 4 (IQR 3–6) versus 3 (IQR 2–5) at recovery (p = 0.12). HS-directed systemic therapy was withheld in 10 patients (91%) without flares. One patient received a short course of oral clindamycin for mild drainage without systemic symptoms. No HS-related bacteremia, sepsis, or wound-healing delays occurred. Conclusions: In AML patients with comorbid HS, induction therapy–induced neutropenia was not associated with worsening HS activity or related infectious complications. These findings suggest that hematologists can safely prioritize leukemia-directed treatment without concern for exacerbating HS during induction, and that a conservative, observation-focused approach to HS management is appropriate in this setting.