Background/Purpose:

Hidradenitis Suppurativa (HS) is an inflammatory skin condition that can cause profound morbidity. Patients can present with recurrent nodules, sinus tract formation, abscesses and/or scarring, mainly affecting intertriginous skin areas. A variety of inflammatory disorders have been associated with HS, such as inflammatory bowel disease (IBD) and spondyloarthropathies. Case reports have documented coexistence between HS and inflammatory eye disease (IED), but associations have not been described. Herein, we aimed to assess the types of IED associated with HS, risk factors for developing IED in patients with HS, and treatment outcomes. 

Methods:

Case identification was performed by including all cases within Cleveland Clinic Health System with a diagnosis of HS (ICD code 705.83) and any IED. Using this strategy, 483 patients were identified. With Cleveland Clinic electronic medical records, a retrospective chart review was done to identify demographics, IED patterns, associated conditions, treatments and outcomes. Ophthalmologic notes were reviewed by an independent ophthalmologist to ensure accuracy of IED diagnosis. Patients with episcleritis and sicca were excluded given their prevalence in the general population. Only those with chronic IED were included. A total of 20 patients with HS and IED met these criteria. Qualitative variables were described with measures of frequency.

Results:

16 patients were female (80%). 12 were African American (60%) and 7 Caucasian (35%). HS was diagnosed before IED in 11 patients (55%). Mean age when HS was diagnosed was 42.15; mean age when IED was diagnosed was 43.65.

13 patients had uveitis (65%), 6 had scleritis (30%) and 1 had peripheral ulcerative keratitis. 8 patients (40%) had a co-morbid IBD: 5 with Crohn’s disease, 1 with ulcerative colitis, and 2 were undifferentiated. RA and common variable immunodeficiency were each diagnosed in 2 patients. There was 1 patient for each of the following conditions: sarcoidosis, AS, psoriasis, Behcet’s disease, multiple sclerosis, SLE, lymphoma, and colon cancer.

Table 1: Treatment of IED with a diagnosis of HS

Conclusion:

HS should be included in the etiology of IED. Female gender and African American ethnicity are common in patients with both IED and HS. The pattern of IED most associated with HS was uveitis followed by scleritis. Among the co-morbidities, IBD is the most prevalent, especially the subset of Crohn’s disease. While topical steroid remains first-line treatment, systemic immunosuppressive agents show promise for refractory eye disease, particularly anti-TNF-alpha biologics among this study group.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hidradenitis-suppuritiva-is-associated-with-inflammatory-eye-disease/