Gender and Age-Related Differences in Biologic Treatment Among Patients with Hidradenitis Suppurativa

Gender and Age-Related Differences in Biologic Treatment Among Patients with Hidradenitis Suppurativa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Gender and Age-Related Differences in Biologic Treatment Among Patients with Hidradenitis Suppurativa Sydney A. Barlow, Christopher A. Guirguis, Joe K. Tung This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7356064/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Biologic therapies have demonstrated significant efficacy in reducing disease burden in hidradenitis suppurativa (HS). However, prolonged delays in treatment access remain common, particularly among marginalized populations. While pediatric disparities in biologic use for HS patients are documented, little is known about treatment inequities in adult populations. Understanding these disparities in biologic access is critical, as delayed initiation of appropriate therapies may represent a missed opportunity to prevent disease progression. Therefore, the current study utilizes data from the All of Us database to examine sociodemographic factors associated with biologic therapy use in adults with HS. Data was obtained from 3,308 adults diagnosed with HS. Multivariable regression was used to assess two outcomes: (1) odds of biologic use and (2) time to biologic initiation based on age, gender, race/ethnicity, income, insurance status, rurality, and health literacy. Smoking status was controlled for across all analyses. The time-to-treatment analysis was restricted to the 195 patients who received biologic therapy. On average, patients were 51.1 years old, predominantly female, non-Hispanic/Latino, insured, and did not report delayed care due to rural residence. Age and sex emerged as important sociodemographic factors influencing biologic therapy use and timing. When examining the odds of receiving biologic therapy, age was the only significant predictor. Specifically, each additional year of age was associated with a 2% decrease in the odds of receiving biologics (OR = 0.98; 95% CI: 0.97–0.99; p < 0.001). In the analysis of time to biologic initiation, both age and gender were significant predictors. Each year increase in age is associated with a 29-day longer delay in starting biologic therapy (β = 29.29; 95% CI: 6.74–51.84; p = 0.01). Similarly, female gender was associated with a significantly longer time to biologic initiation compared to males (β = 1071.52; 95% CI: 369.11–1773.94; p = 0.003). These findings underscore the need for clinician awareness of age and gender related disparities in HS management. Older adults may be under-prioritized for biologic therapy due to prescribing biases or under-recognition of disease severity. Ensuring timely, equitable access is critical to improving outcomes and quality of life for patients with HS. Hidradenitis Suppurativa Biologics Gender Figures Figure 1 Introduction The use of biologic therapies for hidradenitis suppurativa (HS) has increased in recent years, with research demonstrating significant reductions in disease flares. [ 1 ] Despite these advancements, many patients continue to experience prolonged delays in accessing biologic therapy, often enduring years of symptoms and frequent emergency department or inpatient visits before initiation of treatment. [ 2 ] Recent research suggests these delays may not be experienced equally. In pediatric populations, non-Hispanic White patients were more likely to receive biologic therapy (17.4%), specifically adalimumab and infliximab, compared to non-Hispanic Black patients (12.8%). [ 3 ] Similar disparities have been observed in other inflammatory conditions such as psoriasis [ 4 ] and atopic dermatitis [ 5 ] , where non-White patients have lower biologic usage. These disparities in access to advanced therapies may contribute to ongoing disease progression and worsened health outcomes. While disparities in pediatric HS care have been documented, less is known about how these patterns extend to adults. Furthermore, HS disproportionately impacts women [ 6 ] and Black individuals [ 7 ] , further emphasizing the need to investigate treatment access. To address this gap, the current study utilizes data from the All of Us database (AoUDB) to examine sociodemographic factors associated with biologic therapy use in adults with HS. Currently, three biologics are FDA-approved for the treatment of HS, including adalimumab, secukinumab, and bimekizumab. This analysis focuses specifically on adalimumab and secukinumab, as the data cutoff for the AoUDB predates the November 2024 FDA approval of bimekizumab for HS. Methods The current study queried the AoUDB for patients with a diagnosis of HS, yielding a total of 3,381 patients. Next, all FDA-approved biologics for HS (adalimumab and secukinumab) were queried. Participants who received either of the studied biologics prior to their first diagnosis of HS were excluded, yielding 3,308 for inclusion. Multivariate regression was used to examine two outcomes: the odds of receiving a biologic and the time to initiation of biologic use from first diagnosis of HS based on age, gender, race, ethnicity, rural status, income, medical literacy, and medical insurance. Smoking status was controlled for across all analyses. The time-to-treatment analysis was limited to participants who received a biologic, yielding 195 for inclusion. Lastly, to control for multiple comparisons, the Benjamini-Hochberg correction was utilized. Results On average, HS patients included in this study were 51.1 years old. The majority were female (78%), not Hispanic or Latino (81%), had health insurance (93%), and did not report delaying care due to living in a rural area (96%) (Table 1 ). Table 1 Basic Demographics of Analyzed cohort Variable Total Cohort (n = 3,308) Race White, n (%) 1361 (41.1%) Black or African American, n (%) 1136 (34.4%) Asian, n (%) 777 (23.5%) Other, n (%) 34 (1.0%) Gender Female, n (%) 2594 (78.4%) Male, n (%) 634 (19.2%) Other, n (%) 80 (2.4%) Annual Income less than 10k, n (%) 633 (19.1%) 10k 25k, n (%) 568 (17.2%) 25k 35k, n (%) 294 (8.9%) 35k 50k, n (%) 314 (9.5%) 50k 75k, n (%) 335 (10.1%) 75k 100k, n (%) 202 (6.1%) 100k 150k, n (%) 188 (5.7%) 150k 200k, n (%) 72 (2.2%) More than 200k, n (%) 66 (2.0%) Unknown, n (%) 636 (19.2%) Ethnicity Not Hispanic or Latino, n (%) 2686 (81.2%) Hispanic or Latino, n (%) 536 (16.2%) Other ethnicity, n (%) 86 (2.6%) Medical literacy a Not At All, n (%) 81 (2.5%) A Little Bit, n (%) 106 (3.2%) Somewhat, n (%) 335 (10.1%) Quite A Bit, n (%) 643 (19.4%) Extremely, n (%) 2073 (62.7%) Unknown, n (%) 45 (1.4%) Health Insurance Yes, n (%) 3088 (93.4%) No, n (%) 137 (4.1%) Unknown, n (%) 83 (2.5%) Smoking history Yes, n (%) 1660 (50.2%) No, n (%) 1542 (46.6%) Unknown, n (%) 106 (3.2%) Delayed care due to Rural area False, n (%) 3190 (96.4%) True, n (%) 118 (3.6%) Age (Years), mean (SD) 51.07 ± 14.65 * There were 25 patient who did not have any data to indicate their medical literacy. Abbreviations: SD, standard deviation. Age and sex emerged as important sociodemographic factors influencing biologic therapy use and timing. When examining the odds of receiving biologic therapy, age was the only significant predictor. Specifically, each additional year of age was associated with a 2% decrease in the odds of receiving biologics (OR = 0.98; 95% CI: 0.97–0.99; p < 0.001) (Fig. 1 ). There were no significant results for gender, race, ethnicity, rural status, income, medical literacy, or medical insurance. In the analysis of time to biologic initiation, both age and gender were significant predictors. Each year increase in age is associated with a 29-day longer delay in starting biologic therapy (β = 29.29; 95% CI: 6.74–51.84; p = 0.01). Similarly, female gender was associated with a significantly longer time to biologic initiation compared to males (β = 1071.52; 95% CI: 369.11–1773.94; p = 0.003). There were no significant results for race, ethnicity, rural status, income, medical literacy, or medical insurance. Discussion This study adds to the growing body of literature on HS and its clinical management. Our findings indicate that age and gender are significantly associated with access to biologic therapy among adults in the United States. Specifically, older adults were less likely to receive biologic treatment and experienced longer delays in treatment initiation. Additionally, women faced significantly longer delays compared to men. These disparities are particularly concerning given that HS disproportionately affects women. [ 6 ] Importantly, the study highlights a potentially overlooked patient population, older adults, who may not be appropriately prioritized for biologic therapy. These delays may reflect age-related prescribing biases, reduced access to dermatologic care, or underrecognition of disease severity in older adults. However, it is also possible that biologics are underprescribed in older adults due to the higher prevalence of comorbidities in this population, which may increase the risk of adverse effects, including potential medication interactions. [ 8 ] Understanding disparities in biologic access is critical, as delayed initiation of appropriate therapies may represent a missed opportunity to prevent disease progression, reduce high-cost emergency and inpatient healthcare utilization. Limitations of this study include a lack of stratification of HS severity. Additionally, variability across contributing sites in how clinical data are collected, documented, and coded may introduce inconsistencies during the data harmonization process. Lastly, bimekizumab was not included in the current study because it was just approved in November 2024 and is not yet captured in the AoUDB. Future investigations should incorporate bimekizumab when data becomes available. Future research should also incorporate clinical severity measures to better understand barriers to timely treatment. Despite these limitations, the study is strengthened by the use of a national database designed to reflect the diversity of the U.S. population. Ultimately, our findings highlight the need for increased clinician awareness of potential age and gender related disparities in HS management. Timely and equitable access to biologic therapy is essential for improving long-term outcomes and quality of life for patients with HS. Declarations Funding sources : None Conflicts of Interest and Disclosures : Dr. Tung is or has been a clinical trials investigator, consultant, or speaker for AbbVie, Alumis, Amgen, Apogee, Arcutis, Boehringer Ingelheim, BMS, Eli Lilly, Galderma, Incyte, Johnson & Johnson, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharmaceutical, Takeda, and UCB. All other authors have no conflicts of interest to disclose. IRB approval status : The All of Us IRB approved the All of Us protocol and materials before recruitment of the participants into the All of Us database. Acknowledgements: The All of Us Research Program would not be possible without the contributions made by its participants. Patient consent: Not applicable Data availability : The data underlying this article were accessed from the All of Us Dataset version 8 (https://www.researchallofus.org). Reprint requests: Joe K. Tung References Kimball AB et al (2018) The Comorbidity Burden of Hidradenitis Suppurativa in the United States: A Claims Data Analysis. Dermatol Ther (Heidelb) 8(4):557–569 Ring HC et al (2022) The road to biologics in patients with hidradenitis suppurativa: a nationwide drug utilization study. Br J Dermatol 187(4):523–530 Onamusi T, Murphy J, Shah SD Racial Differences in Disease Characteristics of Pediatric Hidradenitis Suppurativa. Pediatric Dermatology. n/a(n/a) Desai R et al (2024) Racial disparities in length of hospitalization and systemic medication utilization in patients with psoriasis. Arch Dermatol Res 317(1):106 Bell MA et al (2020) Racial and Ethnic Disparities in Access to Emerging and Frontline Therapies in Common Dermatological Conditions: A Cross-Sectional Study. J Natl Med Assoc 112(6):650–653 Shih T et al (2021) Gender differences in hidradenitis suppurativa characteristics: A retrospective cohort analysis. Int J Womens Dermatol 7(5Part B):672–674 Anthony MR et al (2023) Unmasking Racial Disparity in the Diagnosis and Treatment of Hidradenitis Suppurativa. Cureus 15(6):e41190 Charrow A, Santiago-Soltero K, Porter M (2024) Biologics in hidradenitis suppurativa: Progress and new directions. J Am Acad Dermatol 91(6):S27–S30 Additional Declarations Competing interest reported. Dr. Tung is or has been a clinical trials investigator, consultant, or speaker for AbbVie, Alumis, Amgen, Apogee, Arcutis, Boehringer Ingelheim, BMS, Eli Lilly, Galderma, Incyte, Johnson & Johnson, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharmaceutical, Takeda, and UCB. All other authors have no conflicts of interest to disclose. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 06 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 06 Oct, 2025 Reviewers invited by journal 02 Oct, 2025 Editor assigned by journal 13 Aug, 2025 Submission checks completed at journal 13 Aug, 2025 First submitted to journal 12 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7356064","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":528347518,"identity":"67d95e01-80ca-4263-beb4-892b4ef19c74","order_by":0,"name":"Sydney A. 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Smoking status was controlled for across all analyses.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7356064/v1/12b20836f5c7ddd3f7a332e3.jpeg"},{"id":93613137,"identity":"b6ec2e22-067e-471d-ab67-df4578efca45","added_by":"auto","created_at":"2025-10-15 16:24:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":600913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7356064/v1/2690c487-1c7b-43f8-b840-993a0102fee7.pdf"}],"financialInterests":"Competing interest reported. Dr. Tung is or has been a clinical trials investigator, consultant, or speaker for AbbVie, Alumis, Amgen, Apogee, Arcutis, Boehringer Ingelheim, BMS, Eli Lilly, Galderma, Incyte, Johnson \u0026 Johnson, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharmaceutical, Takeda, and UCB. All other authors have no conflicts of interest to disclose.","formattedTitle":"Gender and Age-Related Differences in Biologic Treatment Among Patients with Hidradenitis Suppurativa","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe use of biologic therapies for hidradenitis suppurativa (HS) has increased in recent years, with research demonstrating significant reductions in disease flares.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Despite these advancements, many patients continue to experience prolonged delays in accessing biologic therapy, often enduring years of symptoms and frequent emergency department or inpatient visits before initiation of treatment.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eRecent research suggests these delays may not be experienced equally. In pediatric populations, non-Hispanic White patients were more likely to receive biologic therapy (17.4%), specifically adalimumab and infliximab, compared to non-Hispanic Black patients (12.8%).\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Similar disparities have been observed in other inflammatory conditions such as psoriasis \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e and atopic dermatitis\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, where non-White patients have lower biologic usage. These disparities in access to advanced therapies may contribute to ongoing disease progression and worsened health outcomes.\u003c/p\u003e\u003cp\u003eWhile disparities in pediatric HS care have been documented, less is known about how these patterns extend to adults. Furthermore, HS disproportionately impacts women\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e and Black individuals\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, further emphasizing the need to investigate treatment access. To address this gap, the current study utilizes data from the All of Us database (AoUDB) to examine sociodemographic factors associated with biologic therapy use in adults with HS. Currently, three biologics are FDA-approved for the treatment of HS, including adalimumab, secukinumab, and bimekizumab. This analysis focuses specifically on adalimumab and secukinumab, as the data cutoff for the AoUDB predates the November 2024 FDA approval of bimekizumab for HS.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe current study queried the AoUDB for patients with a diagnosis of HS, yielding a total of 3,381 patients. Next, all FDA-approved biologics for HS (adalimumab and secukinumab) were queried. Participants who received either of the studied biologics prior to their first diagnosis of HS were excluded, yielding 3,308 for inclusion. Multivariate regression was used to examine two outcomes: the odds of receiving a biologic and the time to initiation of biologic use from first diagnosis of HS based on age, gender, race, ethnicity, rural status, income, medical literacy, and medical insurance. Smoking status was controlled for across all analyses. The time-to-treatment analysis was limited to participants who received a biologic, yielding 195 for inclusion. Lastly, to control for multiple comparisons, the Benjamini-Hochberg correction was utilized.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOn average, HS patients included in this study were 51.1 years old. The majority were female (78%), not Hispanic or Latino (81%), had health insurance (93%), and did not report delaying care due to living in a rural area (96%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBasic Demographics of Analyzed cohort\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Cohort (n\u0026thinsp;=\u0026thinsp;3,308)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1361 (41.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack or African American, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1136 (34.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e777 (23.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2594 (78.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e634 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnnual Income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eless than 10k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e633 (19.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10k 25k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e568 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25k 35k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e294 (8.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35k 50k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e314 (9.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50k 75k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e335 (10.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e75k 100k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e202 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e100k 150k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e188 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e150k 200k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72 (2.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 200k, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e636 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Hispanic or Latino, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2686 (81.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic or Latino, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e536 (16.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther ethnicity, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedical literacy\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot At All, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e81 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA Little Bit, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomewhat, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e335 (10.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuite A Bit, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e643 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtremely, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2073 (62.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45 (1.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHealth Insurance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3088 (93.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137 (4.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83 (2.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1660 (50.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1542 (46.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDelayed care due to Rural area\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFalse, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3190 (96.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrue, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e118 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (Years), mean (SD)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51.07\u0026thinsp;\u0026plusmn;\u0026thinsp;14.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e*\u003c/sup\u003eThere were 25 patient who did not have any data to indicate their medical literacy. Abbreviations: SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAge and sex emerged as important sociodemographic factors influencing biologic therapy use and timing. When examining the odds of receiving biologic therapy, age was the only significant predictor. Specifically, each additional year of age was associated with a 2% decrease in the odds of receiving biologics (OR\u0026thinsp;=\u0026thinsp;0.98; 95% CI: 0.97\u0026ndash;0.99; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There were no significant results for gender, race, ethnicity, rural status, income, medical literacy, or medical insurance.\u003c/p\u003e\u003cp\u003eIn the analysis of time to biologic initiation, both age and gender were significant predictors. Each year increase in age is associated with a 29-day longer delay in starting biologic therapy (β\u0026thinsp;=\u0026thinsp;29.29; 95% CI: 6.74\u0026ndash;51.84; p\u0026thinsp;=\u0026thinsp;0.01). Similarly, female gender was associated with a significantly longer time to biologic initiation compared to males (β\u0026thinsp;=\u0026thinsp;1071.52; 95% CI: 369.11\u0026ndash;1773.94; p\u0026thinsp;=\u0026thinsp;0.003). There were no significant results for race, ethnicity, rural status, income, medical literacy, or medical insurance.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study adds to the growing body of literature on HS and its clinical management. Our findings indicate that age and gender are significantly associated with access to biologic therapy among adults in the United States. Specifically, older adults were less likely to receive biologic treatment and experienced longer delays in treatment initiation. Additionally, women faced significantly longer delays compared to men. These disparities are particularly concerning given that HS disproportionately affects women.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eImportantly, the study highlights a potentially overlooked patient population, older adults, who may not be appropriately prioritized for biologic therapy. These delays may reflect age-related prescribing biases, reduced access to dermatologic care, or underrecognition of disease severity in older adults. However, it is also possible that biologics are underprescribed in older adults due to the higher prevalence of comorbidities in this population, which may increase the risk of adverse effects, including potential medication interactions.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e Understanding disparities in biologic access is critical, as delayed initiation of appropriate therapies may represent a missed opportunity to prevent disease progression, reduce high-cost emergency and inpatient healthcare utilization.\u003c/p\u003e\u003cp\u003eLimitations of this study include a lack of stratification of HS severity. Additionally, variability across contributing sites in how clinical data are collected, documented, and coded may introduce inconsistencies during the data harmonization process. Lastly, bimekizumab was not included in the current study because it was just approved in November 2024 and is not yet captured in the AoUDB. Future investigations should incorporate bimekizumab when data becomes available. Future research should also incorporate clinical severity measures to better understand barriers to timely treatment. Despite these limitations, the study is strengthened by the use of a national database designed to reflect the diversity of the U.S. population. Ultimately, our findings highlight the need for increased clinician awareness of potential age and gender related disparities in HS management. Timely and equitable access to biologic therapy is essential for improving long-term outcomes and quality of life for patients with HS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;sources\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest and Disclosures\u003c/strong\u003e: Dr. Tung is or has been a clinical trials investigator, consultant, or speaker for AbbVie, Alumis, Amgen, Apogee, Arcutis, Boehringer Ingelheim, BMS, Eli Lilly, Galderma, Incyte, Johnson \u0026amp; Johnson, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharmaceutical, Takeda, and UCB. All other authors have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB\u0026nbsp;approval\u0026nbsp;status\u003c/strong\u003e: The All of Us IRB approved the All of Us protocol and materials before recruitment of the participants into the All of Us database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The All of Us Research Program would not be possible without the contributions made by its participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e: The data underlying this article were accessed from the All of Us Dataset version 8 (https://www.researchallofus.org).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReprint\u0026nbsp;requests:\u0026nbsp;\u003c/strong\u003eJoe K. Tung\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKimball AB et al (2018) The Comorbidity Burden of Hidradenitis Suppurativa in the United States: A Claims Data Analysis. Dermatol Ther (Heidelb) 8(4):557\u0026ndash;569\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRing HC et al (2022) The road to biologics in patients with hidradenitis suppurativa: a nationwide drug utilization study. Br J Dermatol 187(4):523\u0026ndash;530\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOnamusi T, Murphy J, Shah SD \u003cem\u003eRacial Differences in Disease Characteristics of Pediatric Hidradenitis Suppurativa.\u003c/em\u003e Pediatric Dermatology. n/a(n/a)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDesai R et al (2024) Racial disparities in length of hospitalization and systemic medication utilization in patients with psoriasis. Arch Dermatol Res 317(1):106\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBell MA et al (2020) Racial and Ethnic Disparities in Access to Emerging and Frontline Therapies in Common Dermatological Conditions: A Cross-Sectional Study. J Natl Med Assoc 112(6):650\u0026ndash;653\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShih T et al (2021) Gender differences in hidradenitis suppurativa characteristics: A retrospective cohort analysis. Int J Womens Dermatol 7(5Part B):672\u0026ndash;674\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnthony MR et al (2023) Unmasking Racial Disparity in the Diagnosis and Treatment of Hidradenitis Suppurativa. Cureus 15(6):e41190\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCharrow A, Santiago-Soltero K, Porter M (2024) Biologics in hidradenitis suppurativa: Progress and new directions. J Am Acad Dermatol 91(6):S27\u0026ndash;S30\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Hidradenitis Suppurativa, Biologics, Gender","lastPublishedDoi":"10.21203/rs.3.rs-7356064/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7356064/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBiologic therapies have demonstrated significant efficacy in reducing disease burden in hidradenitis suppurativa (HS). However, prolonged delays in treatment access remain common, particularly among marginalized populations. While pediatric disparities in biologic use for HS patients are documented, little is known about treatment inequities in adult populations. Understanding these disparities in biologic access is critical, as delayed initiation of appropriate therapies may represent a missed opportunity to prevent disease progression. Therefore, the current study utilizes data from the All of Us database to examine sociodemographic factors associated with biologic therapy use in adults with HS. Data was obtained from 3,308 adults diagnosed with HS. Multivariable regression was used to assess two outcomes: (1) odds of biologic use and (2) time to biologic initiation based on age, gender, race/ethnicity, income, insurance status, rurality, and health literacy. Smoking status was controlled for across all analyses. The time-to-treatment analysis was restricted to the 195 patients who received biologic therapy. On average, patients were 51.1 years old, predominantly female, non-Hispanic/Latino, insured, and did not report delayed care due to rural residence. Age and sex emerged as important sociodemographic factors influencing biologic therapy use and timing. When examining the odds of receiving biologic therapy, age was the only significant predictor. Specifically, each additional year of age was associated with a 2% decrease in the odds of receiving biologics (OR\u0026thinsp;=\u0026thinsp;0.98; 95% CI: 0.97\u0026ndash;0.99; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the analysis of time to biologic initiation, both age and gender were significant predictors. Each year increase in age is associated with a 29-day longer delay in starting biologic therapy (β\u0026thinsp;=\u0026thinsp;29.29; 95% CI: 6.74\u0026ndash;51.84; p\u0026thinsp;=\u0026thinsp;0.01). Similarly, female gender was associated with a significantly longer time to biologic initiation compared to males (β\u0026thinsp;=\u0026thinsp;1071.52; 95% CI: 369.11\u0026ndash;1773.94; p\u0026thinsp;=\u0026thinsp;0.003). These findings underscore the need for clinician awareness of age and gender related disparities in HS management. Older adults may be under-prioritized for biologic therapy due to prescribing biases or under-recognition of disease severity. Ensuring timely, equitable access is critical to improving outcomes and quality of life for patients with HS.\u003c/p\u003e","manuscriptTitle":"Gender and Age-Related Differences in Biologic Treatment Among Patients with Hidradenitis Suppurativa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 16:15:36","doi":"10.21203/rs.3.rs-7356064/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T20:11:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T22:27:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251593346757920488542937377589869713592","date":"2026-02-06T22:13:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335843579484481972562129874712848344294","date":"2025-10-07T01:45:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-02T14:13:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T16:22:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-13T16:21:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-08-12T12:52:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c14d5ac6-8d1e-4fb3-90f9-d7a652c15b9a","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T14:55:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 16:15:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7356064","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7356064","identity":"rs-7356064","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}