迟发性化脓性汗腺炎：定义一个研究不足的老年人群体。

Hidradenitis suppurativa tarda: defining an understudied elderly population.

机构信息

Departments of Dermatology.

Internal Medicine and Geriatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

出版信息

Br J Dermatol. 2023 Dec 20;190(1):105-113. doi: 10.1093/bjd/ljad317.

DOI:10.1093/bjd/ljad317

PMID:37665963

Abstract

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, devastating, multifactorial skin disease. Patients generally develop HS after puberty and the prevalence of the disease is assumed to decrease with higher age. Data outside the usual age range are limited, especially for elderly patients.

OBJECTIVES

To investigate the prevalence, clinical characteristics and associated comorbidities among the elderly HS population.

METHODS

Data were collected through a population-wide survey-based study within the Lifelines Cohort Study in the Netherlands. The clinical characteristics of elderly patients with HS (≥ 60 years) were compared with an adult population (< 60 years) with HS. The comorbidities in elderly patients with HS were compared with those of a non-HS sex- and age-matched elderly population in a 1 : 4 ratio. HS in the elderly was defined as active HS in patients aged 60 years and older. Within the HS elderly group, two subgroups were defined, late-onset HS (HS developed after 60 years of age) and persistent HS (HS developed from a younger age but continuing after 60 years of age).

RESULTS

Within the Lifelines cohort 209 elderly patients with HS were identified as well as an adult (< 60 years) group with HS (n = 793) and a non-HS sex- and age-matched control elderly group (n = 810). The prevalence of HS among the elderly bootstrap analysis population was 0.8% [95% confidence interval (CI) 0.4-1.2]. A significantly higher age of HS symptom onset was found compared with the adult HS group: respectively, 40 vs. 23 years (odds ratio 1.056, 95% CI 1.05-1.07). Among the elderly HS cohort (in the Discussion, the HS tarda cohort) a female : male ratio of 1.7 : 1.0 and a higher family history for HS were found. Moreover, elderly patients with HS had a significantly higher risk of having HS-associated comorbidities compared with the sex- and age-matched controls.

CONCLUSIONS

The prevalence of HS in the elderly is not rare. Among the elderly a shift from female predominance towards a lower female : male ratio in HS is observed. In addition, HS in the elderly showed significant variation in age of onset and involved body areas. Moreover, elderly patients with HS were more susceptible to multimorbidity. Finally, we propose defining HS in the elderly as 'HS tarda' and subdividing it as late-onset and persistent HS tarda.

摘要

背景

化脓性汗腺炎（HS）是一种慢性、严重的多因素皮肤疾病。患者通常在青春期后发病，且随着年龄的增长，疾病的患病率预计会下降。超出常规年龄范围的数据有限，尤其是针对老年患者。

目的

调查老年 HS 人群的患病率、临床特征和相关合并症。

方法

本研究通过荷兰 Lifelines 队列研究中的一项基于人群的调查收集数据。将老年 HS 患者（≥60 岁）的临床特征与成年 HS 患者（<60 岁）进行比较。将老年 HS 患者的合并症与年龄和性别相匹配的非 HS 老年人群进行比较，比例为 1：4。将 60 岁及以上的老年患者中存在活动性 HS 定义为老年 HS。在老年 HS 患者组中，定义了两个亚组，即迟发性 HS（60 岁以后发病）和持续性 HS（年轻时发病，但 60 岁以后仍持续存在）。

结果

在 Lifelines 队列中，共确定了 209 例老年 HS 患者，以及成年（<60 岁）HS 患者组（n=793）和年龄及性别相匹配的非 HS 老年对照组（n=810）。通过对人口进行自举分析，老年人群中 HS 的患病率为 0.8%（95%置信区间 0.4-1.2）。与成年 HS 组相比，老年 HS 患者的发病年龄明显更高：分别为 40 岁和 23 岁（优势比 1.056，95%置信区间 1.05-1.07）。在老年 HS 患者队列（后文将该队列称为迟发性 HS 队列）中，女性：男性比例为 1.7：1.0，且 HS 的家族史比例更高。此外，与年龄和性别相匹配的对照组相比，老年 HS 患者发生 HS 相关合并症的风险显著更高。