Management of Hidradenitis Suppurativa: Teledermatology Vs In-Person Care in a Western PA Dermatology Practice

Summary: Hidradenitis suppurativa (HS) is an inflammatory skin condition characterized by follicular occlusion and inflammation that lead to pustules, nodules, papules, or abscesses in the axilla, buttocks, or groin1. Diagnoses of HS are often delayed due to lack of access to dermatology care2. Teledermatology (TD) platforms have become an electronic form of healthcare that has increased in utility due to the COVID-19 pandemic. Prior studies have demonstrated that teledermatology platforms- using either synchronous video visits, asynchronous digital imaging, or a hybrid of both-are accurate and effective mediums to increase access to care and to triage patients with more severe conditions to in-person visits more efficiently4,5. To our knowledge, no studies compare these HS care modalities. Our retrospective study analyzes 121 patients from 2021-2024 in 3 populations: in-person patients (40), patients who attended synchronous teledermatology patients (34), and asynchronous eDerm patients (47). We recorded each patient’s age, race, BMI, Hurley Stage, tobacco use, and whether the patient was treated with a biologic. Demographic information is shown in Table 1. P-values were generated using odds ratios with MedCalc Software. In-person and synchronous TD HS patients had similar average BMIs (34.5 vs 38.37), an equal average Hurley stage (1.76 vs 1.76), an equal percentage of patients on biologics (38% vs 38%), and similar percentages of patients of color (12.5% vs 17.6%). Asynchronous patients had a significantly lower average Hurley stage than synchronous or asynchronous patients (1.05 vs 1.76). In-person HS patients were significantly more likely to have comorbidities such as tobacco usage (OR: 4.833, 95CI: 1.9140 to 12.2054, z= 3.334, p=0.0009). Both in person patients and synchronous teledermatology patients were significantly more likely than asynchronous eDerm patients to be prescribed a biologic such as adalimumab or suksecukinumab for their HS (OR: 0.0741, 95%Cl (0.0157 to 0.3505), z=3.282, p=0.0010), (OR: 13.92, 95%CI (2.8797 to 67.3705), z=3.275, p=0.0011). Out of the 3 groups, the asynchronous eDerm consults were the most racially diverse, with more than half of the patients being racial minorities (OR: 7.304, 95% 2.4358, 21.89, Z=3.55, p=0.0004). Our study suggests the demographics, disease severity, and treatment recommendations of HS patients seeking in-patient care are similar to those attending synchronous TD video visits. While asynchronous eDerm consults are effectively used to increase access of dermatologic care to a more racially diverse group of patients, this population has significantly less severe HS. They are also significantly more likely to be treated with non-biologic therapy compared to in person or synchronous teledermatology encounters. Further work should be done to use this modality to help with initial triage of HS management. More advanced HS treatments are more often accomplished via in person or synchronous teledermatology.