Introduction: Hidradenitis suppurativa (HS) is associated with comorbidities that are risk factors for severe COVID-19 infection. We evaluated demographics and COVID-19 outcomes in HS patients. Methods: HS patients with COVID-19 (HS+/COVID+) and a randomized age-, race-, and sex-matched control population of patients without HS with COVID-19 (HS−/COVID+) were selected through a retrospective chart review. Data were collected on demographics, medications, comorbidities, vaccination status, and COVID-19 treatment/outcomes. Fisher’s exact test was used to analyze the relationship between risk factors and COVID-19 outcomes. A p value of <0.05 was considered statistically significant. Results: There were 58 HS+/COVID+ patients, primarily African American (83%, n = 48) and female (88%, n = 51). Compared to HS+/COVID+ patients, HS−/COVID+ patients were significantly more likely to have cardiovascular disease (51% vs. 24%; p = 0.0029) and be pregnant (23% vs. 4%; p = 0.0093). HS+/COVID+ and HS−/COVID+ patients did not vary significantly in vaccination rate at time of COVID-19 diagnosis (6% vs. 5%; p = 0.78). HS−/COVID+ patients were significantly more likely to have COVID-19 complications (35% vs. 7%; p = 0.001) and receive COVID-19 treatment (37% vs. 7%; p = 0.0001) when compared to HS+/COVID+ patients. Conclusion: Our findings support the growing evidence that having HS itself may not be a risk factor for severe COVID-19 outcomes.

© 2023 S. Karger AG, Basel

Hidradenitis suppurativa (HS) is an inflammatory dermatosis associated with comorbidities that are risk factors for severe COVID-19 infection [1]. HS and COVID-19 have been shown to disproportionately affect skin of color patients [2, 3]. There is currently limited knowledge on COVID-19 infection outcomes in HS patients. Herein, we evaluate demographics and COVID-19 outcomes in HS patients at a single hospital system with a high proportion of skin of color patients.

HS and COVID-19 (HS+/COVID+) patients of the University of Arkansas for Medical Sciences (UAMS) from March 2020 to September 2021 were identified through a retrospective electronic medical record review approved by the Institutional Review Board at UAMS. HS patients were selected using International Disease Classification (ICD)-9 code 705.83 and ICD-10 code L73.2 and COVID-19-positive patients using ICD-10 code U07.1. A randomized age-, race-, and sex-matched control population was obtained from non-HS patients at UAMS with a diagnosis of COVID-19 (HS−/COVID+). Data were collected on demographics, immunosuppressive/immunomodulating medications, comorbidities, vaccination status at the time of COVID-19 diagnosis as well as COVID-19 treatment and outcomes. Fisher’s exact test was used to analyze the relationship between risk factors and COVID-19 outcomes in HS+/COVID+ and HS−/COVID+ patients. Comorbidities that varied significantly between HS+/COVID+ and HS−/COVID+ patients were incorporated into a multinomial logistic regression model to better evaluate the impact of HS on outcome variables. The Wald test was used to establish significance in multinomial logistic regression models. A p value of <0.05 was considered statistically significant.

Electronic medical record review yielded 58 HS+/COVID+ and 63 HS−/COVID+. The HS+/COVID+ patients were primarily African American (83%, n = 48) and female (88%, n = 51) with an average age of 38 years (SD 12.7, range 20–79). The most common comorbidities in HS+/COVID+ patients were obesity (72%, n = 42), cardiovascular disease (24%, n = 14), and diabetes mellitus (19%, n = 11).

Compared to HS+/COVID+ patients, HS−/COVID+ patients were significantly more likely to have cardiovascular disease (51% vs. 24%; p = 0.0029) and be pregnant (23% vs. 4%; p = 0.0093). All other comorbidities listed in Table 1 were similar between the two groups. Only 1 patient (HS+/COVID+) was on a biologic medication and did not experience any severe outcomes. HS+/COVID+ and HS−/COVID+ patients did not vary significantly in vaccination rate at time of COVID-19 diagnosis (6% vs. 5%; p = 0.78) or in their vaccination rate at the time of data collection (43% vs. 45%; p = 0.68). 59% of HS+/COVID+ and 65% of HS−/COVID+ patients were diagnosed with COVID-19 prior to public availability of COVID vaccines. HS−/COVID+ patients were significantly more likely to have COVID-19 complications (35% vs. 7%; p = 0.001), hospitalizations (32% vs. 3%; p ≤ 0.0001), received oxygen supplementation (30% vs. 3%; p = 0.0001), and received COVID-19 treatment (37% vs. 7%; p = 0.0001) when compared to HS+/COVID+ patients. These variables maintained significance with multinomial logistic regression.

Demographics and clinical characteristics of HS+/COVID+ and HS−/COVID+ patients

With similar rates of most comorbidities and vaccination rates, HS+/COVID+ patients had no worse COVID-19 outcomes compared to HS−/COVID+ patients. Despite similar rates of most comorbidities and vaccination rates, HS+/COVID+ patients had significantly better COVID-19 outcomes compared to HS−/COVID+ patients. These findings may be due to the more consistent medical care of HS patients in the UAMS system being evaluated for their HS compared to HS−/COVID+ patients presenting for acute care leading to hospitalization. These findings are in line with previous studies demonstrating that HS patients did not have worse COVID-19 outcomes compared to the general population [4, 5]. Limitations include restriction to a single hospital system, retrospective design, and minimal HS severity data. Our study highlights unique trends of COVID-19 infection in a predominantly African American HS population with low use of biologic medications in a geographic region with lower vaccination rates. The findings support the growing evidence that having HS itself may not be a risk factor for severe COVID-19 outcomes.

This study was reviewed and written informed consent was exempted by University of Arkansas for Medical Sciences Institutional Review Board (IRB # 261980).

VYS is on the board of directors for the Hidradenitis Suppurativa Foundation (HSF), is a stock shareholder of Learn Health, and has served as an advisory board member, investigator, speaker, and/or received research funding from Sanofi Genzyme, Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Incyte, Boehringer Ingelheim, Aristea Therapeutics, Menlo Therapeutics, Dermira, Burt’s Bees, Galderma, Kiniksa, UCB, Target-PharmaSolutions, Altus Lab/cQuell, MYOR, Polyfins Techology, GpSkin, Skin Actives Scientific, and the National Eczema Association. JLH is on the board of directors for the Hidradenitis Suppurativa Foundation (HSF) and is a consultant for Novartis and speaker for AbbVie. IHH is a consultant to Abbvie, Pfizer, Incyte, UCB, Boehinger Ingelheim, and Novartis; investigator for Lenicura, Pfizer, Incyte, and Chemocentyx; and board member and president of the HS foundation. The other authors have no conflicts of interest to report.

No funding was received for this study.

Devea R. De: conceptualization (equal), investigation (equal), methodology (equal), writing – original draft preparation (lead), and writing – review and editing (lead). Jonathan W. Rick and Vivian Y. Shi: conceptualization (equal), investigation (equal), methodology (equal), writing – original draft preparation (equal), and writing – review and editing (equal). Terri Shih, Jennifer L. Hsiao, and Iltefat H. Hamzavi: conceptualization (equal), methodology (equal), and writing – original draft preparation (equal).

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

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