Hidradenitis Suppurativa Management in the United States: An Analysis of the National Ambulatory Medical Care Survey and MarketScan Medicaid Databases

Abstract

Purpose: To present nationally representative data demonstrating how frequently hidradenitis suppurativa (HS) occurs in specific groups and how it is currently managed.

Methods: We analyzed data from the 1990-2009 National Ambulatory Medical Care Survey (NAMCS) and the 2003-2007 MarketScan Medicaid databases for patients with a diagnosis of HS (ICD-9-CM code 705.83). Visits per 100,000 population of each race and ethnicity were calculated using the 2000 US Census data for specific demographics.

Results: There were 164,000 patient visits (95% CI: 128,000-200,000) annually with a diagnosis of HS in the NAMCS, and 17,270 HS patients were found in the MarketScan Medicaid over the 5-year period. Antibiotics were the most common treatment, followed by pain medications, topical steroids, and isotretinoin. Prescriptions of biologics and systemic methotrexate, cyclosporine, and acitretin were not observed in the NAMCS. Physicians prescribed medications in 74% of visits and used procedures in 11% of visits. African Americans, females, and young adults had higher numbers of visits for HS.

Conclusions: Our data showing a maximum of 0.06% of the population being treated for HS in a given year are consistent with the low estimates of HS prevalence. Compared to the current prescribing patterns, the more frequent prescription of biologics and systemic treatments may yield better outcomes.

Keywords: Antibiotics; Apocrine glands; Biologics; Demographics; National Ambulatory Medical Care Survey; Tumor necrosis factor inhibitors.

Fig. 1

Estimated NAMCS visits for HS in each year with vertical bars showing the 95% CI. Most years had between 100,000 and 200,000 visits.

Fig. 2

Leading medication classes prescribed for the diagnosis of HS. Antibiotics were prescribed in more than half of HS visits in the NAMCS. Ten categories were prescribed in at least 1% of visits, and pain relievers and topical steroids were the only other categories prescribed in more than 10% of visits.

Fig. 3

Leading medication classes prescribed for the sole diagnosis of HS. Antibiotics were by far the most common treatments prescribed for visits with a sole diagnosis of HS in the NAMCS. Seven categories were prescribed in at least 1% of visits.

Fig. 4

Leading comorbidities in NAMCS patient visits for HS. The 10 comorbidities listed each occurred in at least 2% of visits. ADD = Attention deficit disorder; NEC = not elsewhere classified.

Fig. 5

A substantial percentage of HS visits in the NAMCS were by African American patients, while Hispanic or Latino patients made up a smaller percentage, although some of the visits with unrecorded ethnicity may have been Hispanic or Latino. a NAMCS patient visits for HS by race. b NAMCS patient visits for HS by ethnicity.

Fig. 6

Race/ethnicity of MarketScan patients with HS. MarketScan patients with HS were most frequently black, and 6% were neither white, black, nor Hispanic.

Fig. 7

Number of NAMCS visits for HS by age group with 95% CI. Thick bars show the estimated number of visits; thin vertical bars present the 95% CI for visits in each age group.

Fig. 8

MarketScan patients with HS by age group. In this population, HS diagnoses peaked in the 20s with a steady decline thereafter.

Fig. 9

NAMCS patient visits for HS by physician specialty. The patients were about equally likely to see a general or family physician, general surgeon, or dermatologist.