Publications by authors named "Andrew Strunk"

49 Publications

Prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa.

J Am Acad Dermatol 2021 Jun 16. Epub 2021 Jun 16.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. Electronic address:

Background: Information on prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited.

Objective: To compare prevalence of depression in HS patients with that of controls.

Methods: Cross-sectional analysis of 38,140 adult and 1162 pediatric HS patients and controls identified using data from electronic health records. Primary outcome was prevalent depression.

Results: Prevalence of depression among adults with HS was 30.0% (95% Confidence interval [CI], 29.6-30.5), compared with 16.9% (95% CI, 16.7-17.1) among controls. Among children and adolescents with HS, prevalence of depression was 11.7% (95% CI, 10.0-13.7), compared with 4.1% (95% CI, 3.6-4.7) among controls. In adjusted analyses, adults and children/adolescents with HS had 1.26 (95% CI, 1.25-1.28; P < .001) and 1.42 (95% CI, 0.999-2.01; P = .051) times the odds of having depression relative to controls, respectively.

Limitations: We could not evaluate the influence of disease severity on the outcome.

Conclusion: Depression is prevalent among children, adolescents, and adults with HS. Periodic screening for depression may be warranted.
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http://dx.doi.org/10.1016/j.jaad.2021.06.843DOI Listing
June 2021

Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa.

J Am Acad Dermatol 2021 Jun 11. Epub 2021 Jun 11.

Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York. Electronic address:

Background: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing age. However, pregnancy and maternal outcomes for women with HS are unknown.

Objective: To compare risk of adverse pregnancy and maternal outcomes among women with and without HS and to evaluate the influence of comorbid conditions.

Methods: Retrospective cohort analysis between January 1, 2011, and September 30, 2015.

Results: Compared to control pregnancies (n = 64,218), HS pregnancies (n = 1862) had a higher risk of spontaneous abortion (15.5% vs 11.3%), preterm birth (9.1% vs 6.7%), gestational diabetes mellitus (11.6% vs 8.4%), gestational hypertension (6.1% vs 4.4%), preeclampsia (6.6% vs 3.8%), and cesarean section (32.4% vs 27.1%). Relative risk of some pregnancy and maternal outcomes were attenuated after comorbidity adjustment. In the fully adjusted model, HS pregnancies were independently associated with spontaneous abortion (odds ratio, 1.20; 95% CI, 1.04-1.38), gestational diabetes mellitus (odds ratio, 1.26; 95% CI, 1.07-1.48), and cesarean section (odds ratio, 1.09; 95% CI, 1.004-1.17).

Limitations: We could not evaluate potential influences of disease duration, activity, or severity. Newborn outcomes could not be evaluated.

Conclusion: HS appears to be an independent risk factor for adverse pregnancy and maternal outcomes. This risk is influenced by comorbidities that may be modifiable with early identification and management.
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http://dx.doi.org/10.1016/j.jaad.2021.06.023DOI Listing
June 2021

Risk of psoriasis according to body mass index: A retrospective cohort analysis.

J Am Acad Dermatol 2021 Jun 9. Epub 2021 Jun 9.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Psoriasis has been linked to obesity, although data on the incidence of psoriasis according to body mass index (BMI) are limited.

Objective: To compare incidence of psoriasis among patients stratified by BMI category (normal or underweight, overweight, obese class 1, obese class 2/3).

Methods: Retrospective cohort analysis of a demographically heterogeneous sample of over 1.5 million patients in the United States between January 1, 2008 and September 9, 2019.

Results: Crude incidence of psoriasis per 10,000 person-years was 9.5 (95% confidence interval [CI], 9.1-10.0) among normal or underweight patients, 11.9 (95% CI, 11.4-12.4) among overweight patients, 14.2 (95% CI, 13.6-14.9) among obese class 1 patients, and 17.4 (95% CI, 16.6-18.2) among obese class 2/3 patients. Compared to patients with BMI < 25.0, those who were overweight (adjusted hazard ratio, 1.19; 95% CI, 1.12-1.27; P < .001), obese class 1 (adjusted hazard ratio, 1.43; CI, 1.34-1.53; P < .001) and obese class 2/3 (adjusted hazard ratio, 1.83; CI, 1.71-1.95; P < .001) significantly greater risks for developing psoriasis.

Limitations: Influence of obesity on psoriasis severity could not be measured.

Conclusion: BMI independently influences the development of psoriasis. There appears to be a graded association between BMI and risk of psoriasis.
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http://dx.doi.org/10.1016/j.jaad.2021.06.012DOI Listing
June 2021

Prevalence of inflammatory bowel disease in patients with pyoderma gangrenosum: A population-based analysis.

J Am Acad Dermatol 2021 May 8. Epub 2021 May 8.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.05.006DOI Listing
May 2021

Age- and sex-adjusted prevalence estimates among adults with psoriasis in the United States.

J Am Acad Dermatol 2021 Mar 8. Epub 2021 Mar 8.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2021.03.020DOI Listing
March 2021

Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations.

J Am Acad Dermatol 2021 Jan 23. Epub 2021 Jan 23.

Department of Dermatology, University of California, San Francisco, California.

Background: Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.

Objective: To provide evidence-based screening recommendations for comorbidities linked to HS.

Methods: Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.

Results: Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.

Limitations: Screening recommendations represent one component of a comprehensive care strategy.

Conclusions: Dermatologists should support screening efforts to identify comorbid conditions in HS.
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http://dx.doi.org/10.1016/j.jaad.2021.01.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298595PMC
January 2021

Eruptions and related clinical course among 296 hospitalized adults with confirmed COVID-19.

J Am Acad Dermatol 2021 04 25;84(4):946-952. Epub 2020 Dec 25.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York. Electronic address:

Background: Limited information exists on mucocutaneous disease and its relation to course of COVID-19.

Objective: To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19.

Methods: Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020.

Results: Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance.

Limitations: Skin biopsies were not performed.

Conclusions: Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.
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http://dx.doi.org/10.1016/j.jaad.2020.12.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837130PMC
April 2021

Mucocutaneous disease and related clinical characteristics in hospitalized children and adolescents with COVID-19 and multisystem inflammatory syndrome in children.

J Am Acad Dermatol 2021 02 24;84(2):408-414. Epub 2020 Oct 24.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Little is known about mucocutaneous disease in acutely ill children and adolescents with COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

Objective: To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C.

Methods: Descriptive cohort study of prospectively and consecutively hospitalized eligible patients between May 11, 2020 and June 5, 2020.

Results: In COVID-19 patients, 4 of 12 (33%) had rash and/or mucositis, including erythema, morbilliform pattern, and lip mucositis. In MIS-C patients, 9 of 19 (47%) had rash and/or mucositis, including erythema, morbilliform, retiform purpura, targetoid and urticarial patterns, along with acral edema, lip mucositis, tongue papillitis, and conjunctivitis. COVID-19 patients with rash had less frequent respiratory symptoms, pediatric intensive care unit admission, invasive ventilation, and shorter stay versus COVID-19 patients without rash. MIS-C patients with rash had less frequent pediatric intensive care unit admission, shock, ventilation, as well as lower levels of C-reactive protein, ferritin, D-dimer, and troponin (vs MIS-C without rash). Neutrophil-to-lymphocyte ratio was similar for patients with and without rash in both groups. None of the MIS-C patients met criteria for Kawasaki disease.

Limitations: Small sample sizes.

Conclusions: Mucocutaneous disease is common among children and adolescents with COVID-19 and MIS-C. Laboratory trends observed in patients with rash may prognosticate a less severe course.
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http://dx.doi.org/10.1016/j.jaad.2020.10.060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585496PMC
February 2021

Incidence of psoriasis among adults in the United States: A sex- and age-adjusted population analysis.

J Am Acad Dermatol 2021 Apr 27;84(4):1023-1029. Epub 2020 Nov 27.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Information on recent trends in overall and subgroup incidences in psoriasis is limited.

Objective: To estimate current incidence of psoriasis in the United States, compare incidences among demographic subgroups, and evaluate recent disease trends.

Methods: Retrospective cohort analysis of psoriasis patients identified with electronic health records between 2014 and 2018.

Results: Incidence rate in the overall population (n = 2,152,192) was 63.8 (95% confidence interval [CI] 61.8-65.8) per 100,000 person-years. Incidence increased with age and peaked among individuals aged 70 to 79 years (92.3 [95% CI 85.1-100.0] per 100,000 person-years). Incidence was similar between men (62.8 [95% CI 59.8-65.9] per 100,000 person-years) and women (64.8 [95% CI 62.2-67.4] per 100,000 person-years). Standardized incidence rate for Whites (75.3 [95% CI 72.7-78.0] per 100,000 person-years) was greater than that for Hispanic/Latino patients (52.2 [95% CI 44.9-60.3] per 100,000 person-years; P < .001), patients of other race (54.3 [95% CI 46.5-62.9] per 100,000 person-years; P < .001), and Blacks (24.9 [95% CI 21.4-28.8] per 100,000 person-years; P < .001). Incidence appears to be stable within a recent 5-year period.

Limitations: Estimates were derived from approximately 15% of the health care-seeking US population.

Conclusion: Psoriasis incidence in the United States appears to increase with age, is similar between sexes, and is greatest among Whites.
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http://dx.doi.org/10.1016/j.jaad.2020.11.039DOI Listing
April 2021

Development and Validation of HSCAPS-1: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess.

Dermatology 2020 Oct 23:1-8. Epub 2020 Oct 23.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.

Background: A clinical decision support tool may improve recognition of hidradenitis suppurativa (HS) and reduce diagnosis delay.

Objective: To develop and initially validate a clinical decision support to predict diagnosis of HS and distinguish it from cutaneous abscess of the axilla, groin, perineum, and buttock.

Methods: This was a retrospective, cross-sectional analysis between January 2012 and June 2017 (development set) and July 2017 and March 2019 (validation set). We used an electronic records sample of 56 million patients from the Explorys database to identify patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock. The outcome was predicted probability of HS diagnosis.

Results: Development set included 7,974 patients with mean age of 41.4 years, who were predominantly female (66%) and white (62%). Validation set included 1,560 patients with similar demographic composition. Factors which were stronger independent predictors of HS included female sex (OR 2.17 [95% CI 1.96-2.40]); African American race (1.28 [95% CI 1.15-1.44]); increasing BMI (OR 1.05 [95% CI 1.05-1.06)]; history of acne (OR 3.46 [95% CI 2.83-4.23]); Down syndrome (OR 5.35 [95% CI 2.03-14.12]); and prescription for at least 7 opioid medications in the past year (OR 1.05 [95% CI 0.83-1.33]). Up to age 45 years, increasing age was a stronger predictor of HS diagnosis. The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept -0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076]).

Conclusion: This clinical decision support tool shows good performance in predicting diagnosis of HS and distinguishing it from cutaneous abscess that involves the axilla, groin, perineum, and buttock.
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http://dx.doi.org/10.1159/000511077DOI Listing
October 2020

Burden of Hypertension, Diabetes, Cardiovascular Disease, and Lung Disease Among Women Living With Human Immunodeficiency Virus (HIV) in the United States.

Clin Infect Dis 2021 07;73(1):169-170

Department of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA.

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http://dx.doi.org/10.1093/cid/ciaa1240DOI Listing
July 2021

Low prescription of tumor necrosis alpha inhibitors in hidradenitis suppurativa: A cross-sectional analysis.

J Am Acad Dermatol 2021 May 3;84(5):1399-1401. Epub 2020 Aug 3.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.07.108DOI Listing
May 2021

Risk of new-onset inflammatory bowel disease among patients with acne vulgaris exposed to isotretinoin.

J Am Acad Dermatol 2021 Jan 17;84(1):41-45. Epub 2020 Jul 17.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Data on the risk of inflammatory bowel disease (IBD) among isotretinoin-exposed patients with acne vulgaris (AV) is controversial.

Objective: To compare IBD risk in isotretinoin-exposed and unexposed patients with AV.

Methods: Retrospective cohort analysis of patients with AV with and without isotretinoin exposure identified using electronic health records. Primary outcomes were 6-month and 1-year IBD incidence.

Results: The crude 6-month IBD incidence was 0.08% (21/27,230) among isotretinoin-exposed patients with AV compared to 0.04% (254/631,089) among those unexposed. The crude 1-year IBD incidence was 0.10% (28/27,230) among isotretinoin exposed patients with AV and 0.08% (477/631,089) among those unexposed. The odds of developing IBD within 6 months were 87% higher among isotretinoin-exposed patients with AV compared to those unexposed (adjusted odds ratio, 1.87; 95% confidence interval [CI], 1.20-2.93), although the absolute difference was small (risk difference, 2.6 more cases per 10,000 patients; 95% CI, 0.7-4.5). There was no significant difference in the odds of developing IBD at 1 year between isotretinoin-exposed and unexposed patients with AV (adjusted odds ratio, 1.40; 95% CI, 0.95-2.05).

Limitations: Isotretinoin-exposed patients may be more likely to have IBD detected by a health care provider.

Conclusions: IBD incidence among isotretinoin-exposed patients with AV is very low, and the risk appears similar to that for unexposed patients with AV.
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http://dx.doi.org/10.1016/j.jaad.2020.07.042DOI Listing
January 2021

New-onset depression among children, adolescents, and adults with hidradenitis suppurativa.

J Am Acad Dermatol 2020 Nov 22;83(5):1360-1366. Epub 2020 May 22.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Information on the risk of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited.

Objective: To compare the risk of new-onset depression in patients with HS with that of control individuals.

Methods: Retrospective cohort analysis of 49,280 adult and 3042 pediatric patients with HS and matched control individuals identified by using electronic health record data. The primary outcome was incident depression.

Results: The crude incidence rate was 4.8 per 100 person-years in adult patients with HS compared to 3.0 per 100 person-years in control individuals. Among pediatric patients, the crude incidence rate was 4.2 per 100 person-years in patients with HS compared with 2.3 per 100 person-years in control individuals. In adjusted analysis, adults and pediatric patients with HS had a 10% (hazard ratio, 1.10; 95% confidence interval, 1.07-1.13; P < .001) and 26% (hazard ratio, 1.26; 95% confidence interval, 1.10-1.44; P < .001), respectively, increased risk of developing depression compared to control individuals. Among patients with HS, factors associated with depression included female sex, white race, smoking, and body mass index/obesity in adults and pediatric patients and substance abuse in adults only.

Limitations: Patients not seeking care in health systems within the database were not captured.

Conclusion: Children, adolescents, and adults with HS are at an increased risk for developing depression, independent of other common risk factors for depression.
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http://dx.doi.org/10.1016/j.jaad.2020.05.090DOI Listing
November 2020

Real-world risk of new-onset inflammatory bowel disease among patients with psoriasis exposed to interleukin 17 inhibitors.

J Am Acad Dermatol 2020 Aug 11;83(2):382-387. Epub 2020 Apr 11.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Information on the real-world risk of inflammatory bowel disease (IBD) among patients with psoriasis exposed to interleukin-17 inhibitor (IL-17i) is limited.

Objective: To compare IBD risk in patients with psoriasis with and without IL-17i exposure.

Methods: Retrospective cohort analysis of patients with psoriasis with and without IL-17i exposure identified by using electronic health records data. Primary outcomes were 6-month and 1-year IBD incidence.

Results: Crude 6-month IBD incidence was 0.16% (3/1821) among patients with psoriasis exposed to any IL-17i, 0.24% (3/1246) among those exposed to secukinumab alone, and 0.11% (239/213,060) among those unexposed. Crude 1-year IBD incidence was 0.27% (5/1821) among IL-17i-exposed patients with psoriasis, 0.32% (4/1246) among those exposed to secukinumab alone, and 0.19% (412/213,060) among those unexposed. In adjusted analysis, there was no significant difference in odds of developing IBD at 6 months (odds ratio, 1.42; 95% confidence interval, 0.45-4.43) and 1 year (odds ratio, 1.37; 95% confidence interval, 0.57-3.33) between exposed and unexposed patients with psoriasis. Similarly, there was no significant difference in odds of developing IBD at 6 months and 1 year between secukinumab-exposed and -unexposed patients with psoriasis.

Limitations: Analysis may have been limited by the low number of outcome events.

Conclusion: The incidence of IBD among patients with psoriasis exposed to IL-17i is low, and the risk appears similar to that for unexposed patients with psoriasis.
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http://dx.doi.org/10.1016/j.jaad.2020.04.010DOI Listing
August 2020

Incidence of Myocardial Infarction and Cerebrovascular Accident in Patients With Hidradenitis Suppurativa.

JAMA Dermatol 2020 01;156(1):65-71

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.

Importance: Although hidradenitis suppurativa (HS) is associated with several cardiovascular risk mediators, information on the risk of myocardial infarction (MI) and cerebrovascular accident (CVA) in this population is sparse.

Objective: To compare risk of MI, CVA, and composite disease (MI or CVA) in patients with HS, stratified by use of biologic agents, with controls without HS.

Design, Setting, And Participants: A retrospective cohort analysis was conducted between January 1, 1999, and April 1, 2019, using a demographically heterogeneous population-based sample of over 56 million unique patients. Individuals with HS (n = 49 862) and without HS (n = 1 421 223) were identified using electronic health records data.

Main Outcomes And Measures: The primary outcome was incidence of composite MI or CVA.

Results: Of the 49 862 patients with HS, 37 981 were women (76.2%), 29 711 were white (59.6%), and mean (SD) age was 38.3 (13.3) years. Crude incidence rate of composite disease was 6.6 (95% CI, 6.3-7.0) per 1000 person-years in patients with HS compared with 6.8 (95% CI, 6.7-6.8) per 1000 person-years in controls. In patients with HS, crude incidence rates were 2.9 (95% CI, 2.6-3.1) per 1000 person-years for MI alone and 4.1 (95% CI, 3.9-4.4) per 1000 person-years for CVA alone compared with 3.2 (95% CI, 3.18-3.25) per 1000 person-years for MI alone in control patients and 4.1 (95% CI, 4.0-4.1) per 1000 person-years for CVA alone in control patients. In adjusted analysis, patients with HS had a 23% increased risk of composite disease (hazard ratio [HR], 1.23; 95% CI, 1.17-1.30; P < .001) and a similar increase in the risk of MI alone (HR, 1.21; 95% CI, 1.12-1.32; P < .001) and CVA alone (HR, 1.22; 95% CI, 1.14-1.31; P < .001) compared with control patients. The relative difference in composite MI or CVA risk between patients with HS and controls was highest among younger patients HR in subgroup aged 18-29 years: 1.67; 95% CI, 1.37-2.03).

Conclusions And Relevance: Patients with HS appear to have an increased risk of MI and CVA. Early management of modifiable cardiovascular risk mediators may be warranted in patients with HS.
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http://dx.doi.org/10.1001/jamadermatol.2019.3412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865223PMC
January 2020

Incidence of Long-term Opioid Use Among Opioid-Naive Patients With Hidradenitis Suppurativa in the United States.

JAMA Dermatol 2019 Nov;155(11):1284-1290

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.

Importance: Risk of long-term opioid use among patients with hidradenitis suppurativa (HS), who experience pain that substantially impairs quality of life, is unknown to date.

Objective: To compare overall and subgroup incidence of long-term opioid use in a population of opioid-naive patients with HS and control patients.

Design, Setting, And Participants: This retrospective cohort study was based on a demographically heterogeneous population-based sample of more than 56 million unique patients from January 1, 2008, through December 10, 2018. Patients with HS (n = 22 277) and controls (n = 828 832) were identified using electronic health records data. Data were analyzed from December 13, 2018, through January 28, 2019.

Main Outcomes And Measures: The primary outcome was incident long-term opioid use.

Results: Among the 22 277 patients with HS, mean (SD) age was 40.8 (14.6) years, 16 912 (75.9%) were women, and 13 190 (59.2%) were white. Crude 1-year incidence of long-term opioid use among opioid-naive patients with HS was 0.33% (74 of 22 277), compared with 0.14% (1168 of 828 832) among controls (P < .001). In adjusted analysis, patients with HS had 1.53 (95% CI, 1.20-1.95; P < .001) times the odds of new long-term opioid use compared with controls. Among patients with HS, advancing age (odds ratio [OR], 1.02 per 1-year increase; 95% CI, 1.00-1.03; P = .05), ever smoking (OR, 3.64; 95% CI, 2.06-6.41; P < .001), history of depression (OR, 1.97; 95% CI, 1.21-3.19; P = .006), and baseline Charlson comorbidity index score (OR, 1.15 per 1-point increase; 95% CI, 1.03-1.29; P = .01) were associated with higher odds of long-term opioid use. Among patients with HS and long-term opioid use, 4 of 74 (5.4%) were diagnosed with opioid use disorder during the study period. The most frequent schedule II opioid prescriptions included oxycodone hydrochloride (55 of 74 patients [74.3%]), hydrocodone bitartrate (44 [59.5%]), hydromorphone hydrochloride (16 [21.6%]), morphine sulfate (13 [17.6%]), and fentanyl citrate (6 [8.1%]). Tramadol hydrochloride (32 [43.2%]) represented the most frequent non-schedule II prescription. Disciplines prescribing the most opioids to patients with HS included primary care (398 [72.8%]), anesthesiology/pain management (48 [8.8%]), gastroenterology (25 [4.6%]), surgery (23 [4.2%]), and emergency medicine (10 [1.8%]).

Conclusions And Relevance: In this study, patients with HS were at higher risk for long-term opioid use. These results suggest that periodic assessment of pain and screening for long-term opioid use may be warranted, particularly among patients who are older, who smoke tobacco, or who have depression and other medical comorbidities.
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http://dx.doi.org/10.1001/jamadermatol.2019.2610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739733PMC
November 2019

Association between obesity and hidradenitis suppurativa among children and adolescents: A population-based analysis in the United States.

J Am Acad Dermatol 2020 02 20;82(2):502-504. Epub 2019 Aug 20.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.08.034DOI Listing
February 2020

Prevalence estimates for pyoderma gangrenosum in the United States: An age- and sex-adjusted population analysis.

J Am Acad Dermatol 2020 Aug 7;83(2):425-429. Epub 2019 Aug 7.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: The disease burden of pyoderma gangrenosum (PG) is poorly understood.

Objective: To determine standardized overall and age-, sex-, and race-specific prevalence estimates for PG among adults in the United States.

Methods: Cross-sectional analysis of 1971 patients with PG identified using electronic health records data from a diverse population-based sample of more than 58 million patients.

Results: The age- and sex-standardized prevalence of PG among the study population was 0.0058%, or 5.8 PG cases (95% confidence interval [CI], 5.6-6.1) per 100,000 adults. Adjusted prevalence was nearly twice as high among women (7.1 cases [95% CI, 6.7-7.5] per 100,000) than men (4.4 cases [95% CI, 4.0-4.7] per 100,000). Patients between the ages of 70 and 79 years had the highest standardized prevalence (9.8 cases [95% CI, 8.8-10.9] per 100,000), with patients aged ≥50 years representing nearly 70% of all PG cases. Standardized prevalence was similar among white and African American patients. The female-to-male ratio of PG was >1.8 across all age groups.

Limitations: Analysis of electronic health records data may result in misclassification bias.

Conclusion: PG is a rare disease that most commonly affects women and those aged ≥50 years.
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http://dx.doi.org/10.1016/j.jaad.2019.08.001DOI Listing
August 2020

Evaluating patients' unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project.

J Am Acad Dermatol 2020 Feb 3;82(2):366-376. Epub 2019 Jul 3.

Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland.

Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy.

Objective: To evaluate unmet needs from the perspective of HS patients.

Methods: Prospective multinational survey of patients between October 2017 and July 2018.

Results: Before receiving a formal HS diagnosis, 63.7% (n = 827) of patients visited a physician ≥5 times. Mean delay in diagnosis was 10.2 ± 8.9 years. Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4% [n = 798]) rated recent HS-related pain as moderate or higher, and 4.5% described recent pain to be the worst possible. Access to dermatology was rated as difficult by 37.0% (n = 481). Patients reported visiting the emergency department and hospital ≥5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n = 563), and 14.5% were disabled due to disease. Patients reported a high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.6%, respectively.

Limitations: Data were self-reported. Patients with more severe disease may have been selected.

Conclusion: HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address.
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http://dx.doi.org/10.1016/j.jaad.2019.06.1301DOI Listing
February 2020

All-cause mortality among patients with hidradenitis suppurativa: A population-based cohort study in the United States.

J Am Acad Dermatol 2019 Oct 13;81(4):937-942. Epub 2019 Jun 13.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York. Electronic address:

Background: The mortality risk for patients with hidradenitis suppurativa (HS) is largely unknown.

Objective: To compare mortality risk among individuals with and without HS in the United States.

Methods: Retrospective cohort study in a population sample identified by using electronic health records data between January 1, 2012, and December 31, 2016. Primary outcome was incidence of 5-year all-cause mortality.

Results: The crude 5-year mortality rate among patients with HS was 2.4% (321/13 289), compared with 2.7% (18 508/685 573) among control individuals. In the fully adjusted model, the increase in HS mortality risk was 14% (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01-1.28). Overall, excess risk of death attributable to HS was 3.1 deaths per 1000 patients (95% CI, 0.2-6.0) during the study period. Characteristics associated with mortality among patients with HS included age (OR, 1.05; 95% CI, 1.04-1.06), male sex (OR, 1.40; 95% CI, 1.09-1.79), ever-smoking status (OR, 1.48; 95% CI, 1.16-1.92), and Charlson Comorbidity Index score (OR, 1.25; 95% CI, 1.21-1.29).

Limitations: The follow-up period may not have been long enough to assess the influence of disease severity or duration on mortality.

Conclusion: HS appears to confer an independent risk of all-cause mortality. This risk is also influenced by tobacco smoking and comorbidities, which may be modifiable.
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http://dx.doi.org/10.1016/j.jaad.2019.06.016DOI Listing
October 2019

In Response: Overall and Subgroup Prevalence of Acne Vulgaris Among Patients with Hidradenitis Suppurativa.

J Am Acad Dermatol 2019 May 16. Epub 2019 May 16.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.05.028DOI Listing
May 2019

Comparative Overall Comorbidity Burden Among Patients With Hidradenitis Suppurativa.

JAMA Dermatol 2019 07;155(7):797-802

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.

Importance: The overall comorbidity burden among patients with hidradenitis suppurativa (HS) has not been systematically evaluated.

Objectives: To investigate the standardized overall comorbidity burden among patients with HS and to compare it with the comorbidity burden in patients with psoriasis and a control group.

Design, Setting, And Participants: A cross-sectional analysis was conducted of 5306 patients with HS, 14 037 patients with psoriasis, and 1 733 810 controls identified using electronic health records data from October 1, 2013, through October 1, 2018.

Main Outcome And Measure: The primary outcome was the mean Charlson Comorbidity Index (CCI) score.

Results: Each matched cohort had 3818 patients (2789 women and 1029 men; mean [SD] age, 45.7 [15.0]). Before matching, the overall mean (SD) CCI score was highest among the psoriasis cohort (2.33 [3.13]), followed by the HS cohort (1.80 [2.79]) and control cohort (1.26 [2.35]). In matched analyses, the overall mean (SD) CCI score was highest among the HS cohort (1.95 [2.96]), followed by the psoriasis cohort (1.47 [2.43]; P < .001) and control cohort (0.95 [1.99]; P < .001) patients. A total of 516 patients with HS (13.5%) had an overall mean CCI score of 5 or greater. Mean CCI score was highest for patients with HS across all sex, race, and age groups. The most common comorbidities among patients with HS were chronic pulmonary disease (1540 [40.3%]), diabetes with chronic complications (365 [9.6%]), diabetes without chronic complications (927 [24.3%]), and mild liver disease (455 [11.9%]). Patients with HS with a CCI score of 5 or greater had 4.97 (95% CI, 1.49-16.63) times the adjusted risk of 5-year mortality compared with patients with HS with a CCI score of zero.

Conclusions And Relevance: Patients with HS have a higher overall comorbidity burden compared with patients with psoriasis and a control group. A significant proportion of patients with HS have CCI scores of 5 or greater, which are associated with increased mortality. This degree of comorbidity burden may warrant multidisciplinary implementation of routine screening measures.
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http://dx.doi.org/10.1001/jamadermatol.2019.0164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583885PMC
July 2019

Reply to: "Comment on 'Incidence of pneumocystosis among patients exposed to immunosuppression'".

J Am Acad Dermatol 2019 08 30;81(2):e49-e50. Epub 2019 Mar 30.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.03.072DOI Listing
August 2019

Prevalence Estimates for Pemphigus in the United States: A Sex- and Age-Adjusted Population Analysis.

JAMA Dermatol 2019 May;155(5):627-629

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.

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http://dx.doi.org/10.1001/jamadermatol.2018.5954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506879PMC
May 2019

Prevalence estimates for chronic urticaria in the United States: A sex- and age-adjusted population analysis.

J Am Acad Dermatol 2019 Jul 11;81(1):152-156. Epub 2019 Mar 11.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: Disease burden in chronic urticaria (CU) is poorly understood.

Objective: To estimate standardized overall and sex-, age-, and race-specific prevalence estimates for CU among adults in the United States.

Methods: A cross-sectional analysis with electronic health records data for a demographically heterogeneous population-based sample of >55 million patients across all 4 census regions.

Results: The overall CU prevalence was 0.23%, or 230 CU cases/100,000 adults. The adjusted prevalence in women was 310 (95% confidence interval [CI] 307-312) cases/100,000 adults, more than twice that of men (146 [95% CI 143-148] cases/100,000 adults, P < .001). CU prevalence was highest among patients aged 40-49 years (256 [95% CI 252-261] cases/100,000 adults) and 50-59 years (246 [95% CI 242-251] cases/100,000 adults) compared with all other age groups (P < .0001). Adjusted prevalences for black (292 [95% CI 285-298] cases/100,000 adults) and other (331 [95% CI 323-338] cases/100,000 adults) patients were higher than that for white patients (262 [95% CI 260-264] cases/100,000 adults; P < .001).

Limitations: Use of administrative data has the potential to underestimate burden.

Conclusion: There are >500,000 people estimated to have CU in the United States, most of whom are women or adults ≥40 years of age.
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http://dx.doi.org/10.1016/j.jaad.2019.02.064DOI Listing
July 2019

Overall and subgroup prevalence of pyoderma gangrenosum among patients with hidradenitis suppurativa: A population-based analysis in the United States.

J Am Acad Dermatol 2019 Jun 7;80(6):1533-1537. Epub 2019 Feb 7.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York. Electronic address:

Background: Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are reported to coexist, although the prevalence of PG among patients with HS has not been systematically evaluated.

Objective: To evaluate PG prevalence among patients with HS.

Methods: Cross-sectional analysis of adults with PG among patients with HS and patients without HS through use of electronic health records data from a population-based sample of 55 million patients.

Results: The prevalence of PG among 68,232 patients with HS was 0.18% (125 of 68,232), compared with 0.01% (1835 of 31,435,166) among those without HS (P < .0001). Prevalence was markedly higher among patients with HS and Crohn's disease (CD) (3.68%) than among patients with HS but without CD (0.12%). The odds of having PG were 21.14 (95% confidence interval [CI], 17.51-25.51) times greater among patients with HS than among those without HS. Patients with HS with CD had 12.38 (95% CI, 9.15-16.74) times the odds of having PG than did patients without HS but with CD. Among patients without CD, compared with patients without HS, those with HS had 26.51 (95% CI, 21.07-33.36) times the odds of having PG.

Limitations: We could not establish HS phenotype among those having coexistent PG, nor could we distinguish syndromic from nonsyndromic cases.

Conclusion: Patients with HS have an increased prevalence of PG, regardless of CD status. Painful ulcerations among patients with HS warrant additional evaluation for PG.
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http://dx.doi.org/10.1016/j.jaad.2019.02.004DOI Listing
June 2019

Constant Observation Practices for Hospitalized Persons With Dementia: A Survey Study.

Am J Alzheimers Dis Other Demen 2019 06 31;34(4):223-230. Epub 2019 Jan 31.

6 Department of Medicine, Division of Geriatrics and Palliative Medicine, Northwell Health, New York, NY, USA.

Despite substantial staffing and cost implications, the use of constant observation (CO) has been poorly described in the acute care setting. The purpose of this cross-sectional, multicenter, survey study was to assess hospital provider practices regarding the use of CO. Of the 543 surveys distributed, 231 were completed across 5 sites. Most respondents worked on medical units (67.5%), as nurses (49.1%); 44.8% were white; and 75.6% were female. The majority (84.2%) reported at least 1 patient/wk requiring CO. Most frequent indication for CO was dementia with agitation (60.7%), in patients older than 70 (62.3%) and predominantly by nurse assistants (93.9%). Almost half (47.3%) stated they felt pressured to discontinue CO, despite a strong perceived benefit (76%). Enhanced observation (92.6%) was most frequently used to decrease CO. Finally, 77.9% perceived that those performing CO lacked training. Our study highlights the widespread use of CO for hospitalized older adults with dementia.
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http://dx.doi.org/10.1177/1533317519826272DOI Listing
June 2019

Association Between Hidradenitis Suppurativa and Lymphoma.

JAMA Dermatol 2019 05;155(5):624-625

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.

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http://dx.doi.org/10.1001/jamadermatol.2018.5230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506877PMC
May 2019

Incidence of pneumocystosis among patients exposed to immunosuppression.

J Am Acad Dermatol 2019 Jun 9;80(6):1602-1607. Epub 2019 Jan 9.

Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. Electronic address:

Background: The decision to administer prophylaxis to patients receiving immunosuppression against pneumocystosis remains a dilemma.

Objective: To determine overall and age-specific 5-year pneumocystosis incidence within a population exposed to immunosuppressants.

Methods: Retrospective cohort analysis identifying incident pneumocystosis cases among adults without HIV, AIDS, or cancer exposed to immunosuppressant, corticosteroid therapy, or both.

Results: We identified 406 new cases among patients prescribed an immunosuppressant, corticosteroid, or both. Overall incidence of pneumocystosis was 0.012% (406/3,366,086). Incidence was highest in those exposed to immunosuppressant and corticosteroid medications (0.199%), followed by those exposed to immunosuppressant alone (0.012%), corticosteroid alone (0.008%), and neither medication (0.001%) (P < .001). The greatest risk differences were noted between groups exposed to immunosuppressant and corticosteroid compared with neither (0.198%, 95% confidence interval [CI] 0.166%-0.230%) or immunosuppressant alone (0.188%, 95% CI 0.155%-0.221%). The greatest relative risks (RRs) were noted among those receiving immunosuppressant and corticosteroid compared with those exposed to neither (RR 122.5, 95% CI 100.9-148.8) or immunosuppressant alone (RR 16.5, 95% CI 7.3-37.4).

Limitations: We could not confirm dose and duration of exposures.

Conclusion: Incidence of pneumocystosis among patients exposed to immunosuppressants is very low. Prophylaxis for patients receiving combination immunosuppressant and corticosteroid therapy, the group at highest risk, might be warranted.
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http://dx.doi.org/10.1016/j.jaad.2018.12.052DOI Listing
June 2019
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