From survey to service

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease associated with substantial physical and psychological burden. Patients frequently experience prolonged diagnostic delay and progressive disease before accessing specialist care. Management of moderate-to-severe HS often requires multidisciplinary input. However, access to coordinated services remains inconsistent across Scotland. Currently, there is no national framework for cross-board discussion of complex cases of HS, and evidence describing patterns of referral and access to tertiary HS care is limited. The primary aims of this study were to describe clinician-reported access to specialist HS services across Scotland, to estimate the perceived burden of patients requiring tertiary input, and to characterize current clinical practice relating to advanced medical and surgical management. A secondary aim was to evaluate clinician support for developing a national multidisciplinary structure to improve HS care delivery. A cross-sectional, anonymous online survey was distributed via the Scottish Dermatology Society (SDS) annual meeting and mailing list (n = 216). Respondents represented all Scottish health boards providing dermatology services. Data were analysed descriptively using Webropol and Microsoft Excel. The study design and reporting followed STROBE guidance for cross-sectional studies. Fifty-nine clinicians responded. Only 5 of 58 (9%) reported access to a dedicated HS clinic. Among 47 respondents quantifying caseload, 68% saw 1–3 patients annually requiring tertiary input, 21% saw 4–6, and 11% saw > 6, suggesting a national burden of approximately 102–186 patients per year. Biologic use was widespread: 93% prescribed tumour necrosis factor-α inhibitors, 54% secukinumab and 24% bimekizumab. Two-thirds used multiple biologic classes, indicating complex and refractory disease. Although 79% reported surgical access, this mainly supported acute intervention rather than planned procedures. HS care across Scotland is variable, with limited access to specialist multidisciplinary services despite a substantial burden of disease. This clinician-led survey informed the establishment of Scotland’s first virtual national HS multidisciplinary meeting via Microsoft Teams, enhancing case discussion, clinician education and equitable service development.

Abstract from Crossref