Outpatient Dermatology Care Linked to Fewer Hospital Readmissions in Hidradenitis Suppurativa

Hidradenitis suppurativa, a chronic inflammatory skin disease that produces recurrent abscesses, draining tunnels, and scarring in areas rich in apocrine glands, has long been recognized as one of dermatology’s most debilitating conditions. Yet its true cost to the health care system has remained difficult to quantify, largely because patients frequently cycle through emergency departments and inpatient wards without ever establishing the longitudinal specialist care that might keep their disease under control. A new retrospective study from the Henry Ford Health System in Detroit, published in the Archives of Dermatological Research, now offers some of the clearest evidence to date that access to outpatient dermatology can measurably reduce the burden of hospitalization in this population.

The research team, led by co-first authors Akash Rau of Michigan State University College of Human Medicine and Jasira Ziglar of the Department of Dermatology at Henry Ford Health, set out with two linked objectives: to characterize the pattern of inpatient hospitalizations among patients with hidradenitis suppurativa, and to determine whether outpatient dermatology follow-up after discharge influences the risk of readmission. The investigators retrospectively reviewed medical records of adult patients who presented to the emergency department or were admitted to an inpatient service within the Henry Ford Health System between 2010 and 2020, identifying cases through the diagnostic codes ICD-9 705.83 and ICD-10 L73.2.

The scale of the problem became apparent immediately. Among 225 patients with hidradenitis suppurativa who sought care in the emergency department during the study window, 162, or 72 percent, went on to be admitted to an inpatient service. That figure is striking because it suggests that for the majority of these patients, an emergency visit was not a brief detour but the gateway to a costly admission. Hospitalization for a chronic skin disease carries substantial expense, and prior analyses of United States administrative claims data have documented that patients with hidradenitis suppurativa generate health care utilization and costs that far exceed those of matched controls, with emergency and inpatient services representing a disproportionate share of spending.

Within the admitted cohort, the researchers identified two groups that would form the core of their comparison. Thirty-nine patients were admitted and subsequently followed up with dermatology as outpatients, while 68 patients were admitted but never established dermatology care. This natural experiment allowed the team to ask a question that has important implications for health policy: does connecting hospitalized patients to a dermatologist after discharge actually change their trajectory, or are readmissions driven entirely by the underlying severity of the disease?

The answer, according to the study, is that dermatology follow-up matters. Patients who established outpatient dermatology care after their admission experienced significantly fewer readmissions within one year compared with those who did not. The finding underscores a principle that clinicians have long suspected but rarely been able to demonstrate with institutional data: timely, longitudinal management of hidradenitis suppurativa by a specialist can interrupt the cycle of flare, emergency presentation, admission, discharge, and relapse that characterizes so many cases of advanced disease.

The biological rationale for this effect is well understood. Hidradenitis suppurativa is driven by follicular occlusion and dysregulated immune signaling, with contributions from pathways involving interleukin-17 and tumor necrosis factor that have been successfully targeted by biologic therapies. Effective outpatient management can include wound care, antibiotics, hormonal therapies, biologics, pain control, and lifestyle interventions, along with surgical referral for refractory disease. When patients lack access to these modalities, their disease is managed episodically, often with incision and drainage in the emergency department, an approach that addresses the acute abscess but does nothing to suppress the systemic inflammation that will produce the next one.

Delayed diagnosis compounds the problem. Previous research, including a study of delayed diagnosis and its effect on patients and the health care system published in Dermatology, has shown that patients with hidradenitis suppurativa often wait years for a correct diagnosis, during which their disease progresses from isolated nodules to interconnected sinus tracts and irreversible scarring. The condition is also accompanied by a heavy comorbidity burden; a comparative analysis published in JAMA Dermatology found that patients with the disease carry greater overall comorbidity than matched populations, including higher rates of metabolic and cardiovascular disease, depression, and smoking-related illness. These factors increase the complexity and cost of every hospital encounter.

The psychosocial dimension of the disease adds another layer of urgency. Pain, malodor, and disfigurement contribute to social isolation, unemployment, and profound reductions in quality of life, and patients frequently describe feelings of shame that delay presentation until disease is severe. Emergency departments, which are structurally designed for acute stabilization rather than chronic disease management, become the default point of contact for a population that needs exactly the opposite: continuity, trust, and a clinician who knows the full history. The Henry Ford findings suggest that every admission represents a missed opportunity to enroll a patient in that kind of relationship.

From a health economics standpoint, the implications are considerable. Hospital readmissions are a well-recognized target for cost reduction, and value-based care frameworks, as articulated in work on redefining health care by Porter and Teisburg, argue that outcomes per dollar improve when care is organized around the natural course of a condition rather than around fragmented episodes. Hidradenitis suppurativa fits this logic precisely. An outpatient dermatology visit is inexpensive relative to an inpatient admission, and if it prevents even a fraction of readmissions, the return on investment is substantial. The authors of the new study explicitly frame their results as support for targeted interventions to expand outpatient dermatology access as a means of reducing avoidable, high-cost care.

The study has limitations inherent to its design. It was conducted at a single health system, involved a modest sample size of 107 admitted patients in the two comparison groups, and relied on retrospective chart review with diagnostic codes that may not capture every case. Patients who established dermatology follow-up may differ systematically from those who did not, in ways related to insurance, transportation, disease severity, or health literacy, and the authors’ statistical analysis, supported by the Department of Biostatistics at Henry Ford Health, cannot fully exclude such confounding. Data were not available for sharing due to institutional policies and patient privacy protections, which limits external validation. Nevertheless, the direction and consistency of the association, combined with the strong biological plausibility, make the findings difficult to dismiss.

For clinicians, the practical message is that a hospitalization for hidradenitis suppurativa should trigger a deliberate handoff to dermatology before discharge, in the same way that a heart failure admission triggers cardiology follow-up. For health systems and payers, the message is that dermatology capacity is not a luxury but a cost-containment tool. And for patients, the message is perhaps the most important one: this disease is manageable, and the window in which intervention changes outcomes is real. As the prevalence of hidradenitis suppurativa becomes better appreciated and biologic therapies continue to expand, studies like this one provide the evidence base needed to argue that every patient discharged after an HS admission deserves a dermatology appointment, not just a prescription for the next flare.

Subject of Research: Inpatient hospitalizations for hidradenitis suppurativa and the effect of outpatient dermatology follow-up on hospital readmissions

Article Title: Characterizing inpatient hospitalizations for hidradenitis suppurativa and assessing the impact of outpatient dermatology care on hospitalizations

Article References: Rau, A., Ziglar, J., Bardhi, R., Maghfour, J., Liu, V., Jones, B., Budhathoki, N., Huggins, R. H., & Hamzavi, I. H. (2026). Characterizing inpatient hospitalizations for hidradenitis suppurativa and assessing the impact of outpatient dermatology care on hospitalizations. Archives of Dermatological Research, 318(1), Article 387. https://doi.org/10.1007/s00403-026-04870-7

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04870-7

Keywords: hidradenitis suppurativa, dermatology, hospital readmissions, emergency department, inpatient care, access to care, chronic inflammatory skin disease, health care utilization, comorbidities, retrospective study, outpatient follow-up, health economics