Hidradenitis suppurativa with and without draining tunnels: A real-world study characterizing differences in treatment and disease burden

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, neutrophilic skin disease associated with a considerable clinical burden. In more severe disease, subepidermal draining tunnels may form. Objectives: To characterize the clinical profile of patients with moderate–severe HS with and without draining tunnels, and the clinical and health-related quality of life (HR-QoL) burden of draining tunnels. Methods: Data were drawn from the Adelphi HS Disease Specific Programme™, a cross-sectional survey with retrospective data collection, across the United States, France, Germany, Italy, Spain and the United Kingdom between November 2020 and April 2021. Patients were aged ≥10 years and had HS. Clinical outcomes, recorded by physicians, comprised patient demographics and HS characteristics, symptoms and treatment. HR-QoL measures included patient and physician survey questions, and validated HR-QoL instruments. Results: Of the 580 patients with moderate–severe HS, 46% had draining tunnels. Patients with draining tunnels had more abscesses, inflammatory nodules and scarring than those without. Patients with draining tunnels were significantly (p < 0.05) more likely to be treated with biologics (41% vs. 27%), but often patients with tunnels who were eligible for biologics had not received them. Patients with draining tunnels experienced significantly more inflammation/redness (73% vs. 63%), drainage from lesions (62% vs. 40%) and pain on sitting (48% vs. 37%) than those without (p < 0.05). Draining tunnels were also significantly associated with low mood/depression (30% vs. 18%), sleep disturbance (28% vs. 19%) and fatigue (28% vs. 18%) versus no tunnels (p < 0.05). Physicians agreed that patients with draining tunnels experienced a negative impact of disease compared to those without. This was reflected in patient-reported surveys and HR-QoL instruments. Conclusions: Patients with moderate–severe HS and draining tunnels experience greater clinical and HR-QoL burden than those without, emphasizing the importance of tunnels in disease impact.