Surgical Procedures and Medical Treatments Among Patients With Hidradenitis Suppurativa Before and After Referral to Specialised Dermatological Hospital Care: A Nationwide Registry Study

ABSTRACT Background Hidradenitis suppurativa (HS) is difficult to manage, in part because time to diagnosis is often long. Little is known about how referral of HS patients to specialised care impacts patterns of surgical procedures and drug prescriptions. Objectives To examine surgical procedures and medical treatments of HS patients before and after referral to specialised dermatological hospital care. Methods Using the Danish nationwide registries, all patients with a dermatologist‐verified hospital‐diagnosis of HS from the period 1 January 2000 to 31 December 2020 were identified, and information on all their skin specific surgical procedures and medical prescriptions in the period 1 January 1994 to 31 December 2021 were analysed. Results A total of 10,196 patients were included; 69.9% female; mean age 38.8 (SD 13.5) years at time of first hospital consultation. The frequency of skin specific surgical procedures increased from 10.9% to 22.0% in the year before referral compared to the year after. Also, the use of HS specific topical prescriptions (clindamycin and azelaic acid) and oral antibiotics (tetracyclines and rifampicin/clindamycin) increased, respectively, from 14.8% to 29.1%, and from 17.1% to 25.9%, whereas the use of non‐HS specific oral antibiotics decreased from 70.9% to 61.8%. A total of 341 patients were initiated on adalimumab representing an increase from 0.07% to 0.9% before to after referral. Patients on adalimumab followed similar procedural and drug utilisation patterns but had consistently higher usage of all skin specific surgical procedures and drug prescriptions, before and after referral, compared to patients not treated with biologics. Conclusions After referral to specialised dermatological hospital care, surgical procedures and drug prescriptions increased. Within the cohort of patients treated with adalimumab, initiation of biologic therapy was associated with a reduced need for other HS‐specific treatments and surgeries, indicating improved disease control. Earlier diagnosis and referral of HS patients to specialised care is warranted to improve patient outcomes. To this end, enhancing the education of non‐dermatology physicians may be instrumental in facilitating earlier recognition and referral, thereby contributing to more timely and accurate diagnosis.