Type 1 Diabetes is Associated With Increased Therapeutic Burden in Hidradenitis Suppurativa: A Multicenter Retrospective Matched Case-Control Study

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with multiple systemic comorbidities. Although its association with type 2 diabetes is well established, the clinical impact of coexisting type 1 diabetes (T1D) remains poorly defined. Objectives: To compare the clinical characteristics, disease burden, and therapeutic requirements of patients with HS and T1D with matched HS controls. Methods: We conducted a multicenter retrospective matched case-control study across 3 tertiary dermatology departments. Patients with HS and confirmed T1D were matched 1:3 by age, sex, and baseline Hurley stage. Clinical and therapeutic outcomes were assessed over a standardized 48 week follow-up. Results: Twelve patients with HS and T1D and 33 matched controls were included. Baseline disease severity was comparable. During follow-up, patients with HS + T1D had higher mean International Hidradenitis Suppurativa Severity Score System scores (11.95 vs 6.24; P = .01), more draining tunnels (11.0 vs 3.97; P < .01), received more systemic treatments (4.10 vs 3.06; P = .03), and underwent more surgical procedures (1.67 vs 0.67; P < .01). Conclusions: Patients with HS and coexisting T1D may experience a greater inflammatory and therapeutic burden than matched controls. These findings support closer multidisciplinary management and warrant prospective studies to validate T1D as a potential modifier of HS severity. Limitations: Retrospective design and small sample size.