A Novel Severity Assessment Scoring System for Hidradenitis Suppurativa

Abstract

Importance: The variation in both clinical appearance and responses to diverse treatment options emphasize the importance of an accurate, clinically relevant, yet easy-to-use scoring system in hidradenitis suppurativa.

Objective: To propose and provide validation data for the newly designed Severity Assessment of Hidradenitis Suppurativa score.

Design, setting, and participants: We prospectively assessed disease severity using Hurley staging and the modified Hidradenitis Suppurativa Score in 355 patients referred to Ruhr-University Bochum Department of Dermatology between March 2016 and June 2017. We also assessed disease severity via the Severity Assessment of Hidradenitis Suppurativa score.

Main outcomes and measures: Evaluation and assessment of convergent validity and responsiveness to treatment of the Severity Assessment of Hidradenitis Suppurativa score.

Results: Eighty-eight of the 355 patients (134 [37.7%] men and 221 [62.3%] women with a median [IQR] age of 40 [30-49] years) were classified as Hurley stage I, 221 were Hurley stage II, and 46 were Hurley stage III, with an overall median modified Hidradenitis Suppurativa Score of 31 (interquartile range [IQR], 19.3-53). The median total Severity Assessment of Hidradenitis Suppurativa score was 6 (IQR, 4-9), significantly different among the 3 Hurley groups. The median SAHS score for patients in Hurley stage I was 5 (IQR, 3-6), 6 (IQR, 5-9) for patients in Hurley stage II, and 9 (IQR, 7-12) for patients in Hurley stage III (P < .001, Kruskal-Wallis test). Correlation analysis showed a significant correlation between the modified Hidradenitis Suppurativa Score and the Severity Assessment of Hidradenitis Suppurativa score (r = 0.79, P < .001). Disease severity assessment before and after 3 months of conservative systemic treatment showed a significant correlation between the Severity Assessment of Hidradenitis Suppurativa score and modified Hidradenitis Suppurativa Score. Both the mHSS (P = .001) and the SAHS score (P < .001) significantly differed between the baseline visit (median mHSS, 33 [IQR, 24-52]; median SAHS score, 6 [IQR, 5-9]) and the 3-month visit (median mHSS, 28 [IQR, 15-43.5]; median SAHS score, 5 [IQR, 4-6.3]). The 2 patient-reported items demonstrated excellent test-retest reliability with intraclass correlation coefficient values greater than 0.8.

Conclusions and relevance: Our validation data demonstrated that the Severity Assessment of Hidradenitis Suppurativa score is a disease severity instrument that significantly correlates with Hurley staging and the modified Hidradenitis Suppurativa Score, and is responsive enough to measure treatment outcome.

Figure 1.. Comparison of the Severity Assessment of Hidradenitis Suppurativa (SAHS) Score Between the 3 Hurley Groups

Multiple-comparison box-and-whisker plots showing SAHS score vs the 3 Hurley groups. The median SAHS score was significantly different between each Hurley group and increased with the degree of severity (P < .001, Kruskal-Wallis test). The central box represents the values from the 25th to 75th percentiles. The middle line represents the median. The whiskers extend from the minimum to the maximum value and outliers are represented with separate dots.

Figure 2.. Correlation of the Severity Assessment of Hidradenitis Suppurativa (SAHS) Score and Modified Hidradenitis Suppurativa Score (mHSS)

Correlation analysis showed a significant positive correlation according to Spearman (r = 0.79, P < .001).

Figure 3.. Modified Hidradenitis Suppurativa Score (mHSS) and Severity Assessment of Hidradenitis Suppurativa (SAHS) Score Change During Treatment

Median (with interquartile range) mHSS and SAHS score obtained at baseline and 3 months after conservative systemic treatment. The error bars mark interquartile range. The mHSS (P < .001) and the SAHS score (P < .001) significantly differed between the baseline visit and 3-month visit. In addition, there was a significant correlation according to Spearman between the SAHS score and mHSS obtained at the baseline visit (r = 0.62, P < .001) and 3-month visit (r = 0.78, P < .001).