GLP-1 Receptor Agonist Therapy and Surgical Procedure Rates in Hidradenitis Suppurativa

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Sidhu, Sahil Kapur, Kritin Verma, Sophia Gandarillas, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7603854/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory disease marked by painful nodules, abscesses, and sinus tracts, often requiring interventions such as incision and drainage (I&D) or wide local excision (WLE). These procedures, common in moderate to severe cases, are invasive and prone to recurrence, underscoring the need for therapies that reduce surgical burden. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exhibit anti-inflammatory and immunomodulatory properties, with emerging evidence suggesting potential benefits for HS. The objective was to evaluate the impact of GLP-1 RA therapy on surgical outcomes in patients with HS using population-level data. A retrospective, propensity score–matched cohort analysis was performed on TriNetX comparing rates of HS-related surgical procedures in patients treated with GLP-1 RAs versus matched controls. Patients were matched 1:1 on age, gender, race, and ethnicity, resulting in two balanced cohorts of 20,672 patients each. Exposure to GLP-1 RAs was determined through prescription records, and surgical outcomes were identified using CPT codes. Odds ratios with 95% confidence intervals were included to compare the incidence of surgical intervention between groups. Simple I&D was performed in 5.68% of GLP-1 RA users versus 6.54% of controls, while complicated I&D occurred in 2.38% versus 2.82%. Rates of WLE were also significantly lower in the GLP-1 RA group, including axillary excision, inguinal excision, and perineal or umbilical excision. GLP-1 RA use is associated with a significantly reduced need for surgical interventions, highlighting a possible disease-modifying effect in HS. While surgery may offer remission, it may not be suitable or preferred by all patients, and GLP-1 RAs may require ongoing use and incur long-term costs. Prospective trials are needed to confirm these findings, clarify cost-effectiveness, optimal duration, and patient selection, and to compare outcomes with surgical approaches. hidradenitis suppurativa glucagon-like peptide-1 receptor agonists dermatologic surgery disease modification propensity score matching Figures Figure 1 Full Text Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease marked by recurrent nodules, abscesses, and sinus tracts, predominantly affecting intertriginous areas such as the axillae, groin, and perineum. The disease course is often marked by progressive tissue destruction, scarring, and a significant reduction in quality of life. Surgical interventions include incision and drainage (I&D) or wide local excision (WLE). These procedures, though common in moderate to severe cases, are invasive and prone to recurrence, underscoring the need for therapies that reduce surgical burden and improve long-term outcomes [ 1 ]. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), developed for glycemic control in type 2 diabetes mellitus and more recently used for weight management in obesity, have demonstrated anti-inflammatory and immunomodulatory effects. Emerging evidence suggests that GLP1-RAs may benefit inflammatory skin conditions, including HS, by modulating cytokine profiles and immune cell function [ 2 – 4 ]. However, population-level data evaluating the impact of GLP-1 RA therapy on HS disease course, especially surgical outcomes, remain limited. We performed a retrospective, propensity score–matched cohort analysis using the TriNetX Global federated network to compare the incidence of HS-related surgical procedures in patients treated with GLP-1 RAs versus matched controls. Patients with HS were identified using the International Classification of Diseases (ICD) 10 code L73.2 and matched 1:1 on age, gender, race, and ethnicity, resulting in two balanced cohorts of 20,672 patients each. Exposure to GLP-1 RAs was determined through prescription records, and surgical outcomes were identified using Current Procedural Terminology (CPT) codes. Odds ratios (ORs) with 95% confidence intervals (CIs) were included to compare the incidence of surgical intervention between groups (see Table 1 ). Table 1 Case-Control Analysis of HS-Related Surgical Procedures in Patients Treated With GLP-1 RAs Versus Matched Controls. Outcome (CPT Code) Case (%) (n = 20,672) Controls (%) (n = 20,672) OR (95% CI)† p- value† Age ± SD 44.0 +/- 13.5 44.0 +/- 13.5 - 0.915 White 11,419 (55.2%) 11,424 (55.3%) - 0.961 American Indian or Alaska Native 164 (0.8%) 152 (0.7%) - 0.498 Female 16,938 (81.9%) 16,957 (82.0%) - 0.808 Native Hawaiian or Other Pacific Islander 159 (0.8%) 140 (0.7%) - 0.27 Not Hispanic or Latino 14,226 (68.8%) 14,239 (68.9%) - 0.791 Hispanic or Latino 2,028 (9.8%) 2,012 (9.7%) - 0.89 Black or African American 6,486 (31.4%) 6,499 (31.4%) - 0.89 Male 3,721 (18.0%) 3,706 (17.9%) - 0.848 Asian 376 (1.8%) 371 (1.8%) - 0.854 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single (10060) 1174 (5.7%) 1352 (6.5%) 0.86 (0.79, 0.93) 0.0003* Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple (10061) 491 (2.4%) 582 (2.8%) 0.84 (0.74, 0.95) 0.0049* Excision of skin and subcutaneous tissue for hidradenitis, axillary (1003234) 234 (1.1%) 410 (1.9%) 0.56 (0.48, 0.67) < 0.0001* Excision of skin and subcutaneous tissue for hidradenitis, inguinal (1003237) 150 (0.7%) 240 (1.2%) 0.62 (0.51, 0.75) < 0.0001* Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical (1003240) 110 (0.5%) 215 (1.04%) 0.51 (0.40, 0.64) < 0.0001*​​ † Reported data are after performing a propensity-matched analysis. * Statistically significant data indicated by p < 0.05. Surgical interventions related to HS were significantly less common in patients treated with GLP-1 RAs compared to controls. Simple I&D was performed in 5.68% of GLP-1 RA users versus 6.54% of controls (OR = 0.86, 95% CI: 0.79–0.93), while complicated I&D occurred in 2.38% versus 2.82% (OR = 0.84, 95% CI: 0.74–0.95). Rates of WLE were also significantly lower in the GLP-1 RA group, including axillary excision (1.13% vs. 1.98%; OR = 0.57, 95% CI: 0.48–0.67), inguinal excision (0.73% vs. 1.16%; OR = 0.62, 95% CI: 0.51–0.76), and perineal or umbilical excision (0.53% vs. 1.04%; OR = 0.51, 95% CI: 0.40–0.64) (see Table 1 ). Our large, multicenter analysis demonstrates that treatment with GLP-1 RAs is associated with a significant reduction in the frequency of surgical interventions for patients with HS. The magnitude of effect was most pronounced for WLEs (i.e., perianal, perineal, and umbilical), where GLP-1 RA use was associated with nearly a 50% reduction in surgical burden (see Fig. 1 ). Surgical management of HS, while often necessary, is associated with postoperative complications, prolonged recovery periods, and substantial healthcare costs [ 1 ]. By potentially reducing the frequency and necessity of surgical interventions, GLP-1 RA therapy may improve patient quality of life and decrease healthcare resource utilization. Metabolic dysregulation, including obesity and insulin resistance, has been implicated in the pathophysiology of HS, with obesity being a well-established risk factor for increased disease severity and persistence [ 1 ]. GLP-1 RAs, like liraglutide, improve glycemic control and induce weight loss by enhancing glucose-dependent insulin secretion and reducing appetite. Liraglutide has demonstrated anti-inflammatory properties via the suppression of tumor necrosis factor alpha (TNF-α), nuclear factor-kappa B (NF-κB), and other pro-inflammatory cytokines such as IL-17, IL-22, and IL-23, which are implicated in the pathophysiology of HS [ 1 – 4 ]. These anti-inflammatory properties, combined with demonstrated metabolic effects, position GLP-1 RA therapy as an effective disease-modifying strategy that may address underlying metabolic dysfunction, chronic systemic inflammation, and decrease disease severity [ 2 – 5 ]. Recent case series suggest similar findings and report clinical improvement in HS patients treated with GLP1-RAs, including reductions in lesion count, pain, and flare frequency [ 6 ]. The retrospective study design and reliance on administrative coding introduce potential limitations, including misclassification bias and residual confounding, despite propensity matching. Detailed clinical data on HS severity (i.e., Hurly stage), duration of GLP-1 RA therapy, adherence, and concomitant treatments were not available. Therefore, the ability to perform dose-response or temporal analyses was limited. Carbon dioxide (CO 2 ) laser procedures were also excluded from analysis due to limitations in CPT coding specificity. Future studies should incorporate these interventions, as they are an important and expanding component of HS surgical care. Further research is needed to evaluate the cost-effectiveness of GLP-1 RAs. Surgical procedures, particularly WLEs, can be remittive for some patients, potentially offering long-term or permanent disease control. In contrast, GLP-1 RAs may require ongoing administration, which could result in substantial cumulative costs and may not induce remission. The optimal duration of GLP-1 RA therapy for HS also remains unclear as it is not yet known whether these agents are needed long-term to sustain benefit or if a finite course can achieve significant disease modification. Additionally, it is important to recognize that not all patients are candidates for or desire surgery due to its invasiveness, associated risks, and impact on quality of life. Some patients may elect to pursue less invasive medical management options. The availability of effective non-surgical therapies such as GLP-1 RAs may expand the range of treatment choices, supporting a more individualized and patient-centered approach to HS care. Therefore, future studies should assess the long-term efficacy and cost-benefit profile of GLP-1 RA therapy with respect to patient-reported outcomes and satisfaction across different management strategies. Our findings support and extend prior studies by demonstrating, at population scale, that GLP-1 RA use is associated with a significantly reduced need for surgical interventions. This suggests symptomatic improvement and a measurable decrease in surgical disease burden, highlighting a possible disease-modifying effect of GLP-1 RA therapy in HS. Prospective, randomized controlled trials are needed to confirm these observational findings, elucidate the pathophysiologic mechanisms underlying GLP-1 RA efficacy in HS, and define optimal dosing and patient selection criteria. Additionally, investigating the synergistic effects of GLP-1 RAs with biologic medications such as adalimumab or secukinumab may further enhance therapeutic outcomes. Declarations Funding sources: None Conflicts of Interest: Dr Hamzavi has served as an advisory board member for AbbVie; a consultant for Boehringer Ingelheim, AVITA Medical, Galderma Laboratories LP, Incyte, Pfizer, and UCB; a principal investigator for AVITA, Bayer, Estee Lauder, Ferndale Laboratories, Incyte Corporation, Lenicura, L’Oreal, Pfizer, and Unigen; immediate past president of the HS Foundation; and a board member of the Global Vitiligo Foundation. IRB approval status This study was considered by our IRB to be non-human research and thus exempt from review. Author Contribution KS, SK, SG, KK, and RK assisted with data collection, analysis, and prepared the original draft of the manuscript. KP and IH contributed to reviewing and editing. All authors reviewed and approved the final manuscript. References Alikhan A, Sayed C, Alavi A et al (2019) North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol 81(1):76–90. 10.1016/j.jaad.2019.02.067 Lee YS, Jun HS (2016) Anti-Inflammatory Effects of GLP-1-Based Therapies beyond Glucose Control. Mediat Inflamm 2016(1):3094642. 10.1155/2016/3094642 Vidal SI, Menta N, Nussbaum D, Friedman A (2024) GLP-1 Receptor Agonists for the Dermatologist: Uses and Considerations. J Drugs Dermatol 23(11):1026–1027 Drucker DJ (2018) Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metabol 27(4):740–756. 10.1016/j.cmet.2018.03.001 Garg A, Kirby JS, Lavian J, Lin G, Strunk A (2017) Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States. JAMA Dermatology 153(8):760–764. 10.1001/jamadermatol.2017.0201 Rames MM, Alavi A, Aghazadeh N (2025) GLP-1 Agonists in Patients with Hidradenitis Suppurativa: A Case Series. J Cutan Med Surg Published online Febr 18. 10.1177/12034754251320045 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 01 Feb, 2026 Reviews received at journal 11 Jan, 2026 Reviewers agreed at journal 11 Jan, 2026 Reviewers invited by journal 11 Nov, 2025 Editor assigned by journal 13 Sep, 2025 Submission checks completed at journal 13 Sep, 2025 First submitted to journal 12 Sep, 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-7603854","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":545903470,"identity":"b68136ab-dfbf-44a6-8937-3046b745f1bc","order_by":0,"name":"Kermanjot S. 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1","display":"","copyAsset":false,"role":"figure","size":25849,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot Of Odds Ratios For Incidence Of HS-Related Surgical Procedures Following GLP-1 RA Therapy. *Reported with 95% Confidence Intervals (bars).\u003c/p\u003e\n\u003cp\u003eLegend: WLE; wide local excision, I\u0026amp;D; incision and drainage.\u003c/p\u003e","description":"","filename":"Screenshot20251121111714.png","url":"https://assets-eu.researchsquare.com/files/rs-7603854/v1/c3aaf39e9dedf548dab1ceb5.png"},{"id":96607952,"identity":"9571726e-c956-4c6b-825d-413a11ec9c93","added_by":"auto","created_at":"2025-11-24 09:28:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":410932,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7603854/v1/c3d4955b-4aa7-430e-8b70-6cf61f5cdd49.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"GLP-1 Receptor Agonist Therapy and Surgical Procedure Rates in Hidradenitis Suppurativa","fulltext":[{"header":"Full Text","content":"\u003cp\u003eHidradenitis suppurativa (HS) is a chronic inflammatory skin disease marked by recurrent nodules, abscesses, and sinus tracts, predominantly affecting intertriginous areas such as the axillae, groin, and perineum. The disease course is often marked by progressive tissue destruction, scarring, and a significant reduction in quality of life. Surgical interventions include incision and drainage (I\u0026amp;D) or wide local excision (WLE). These procedures, though common in moderate to severe cases, are invasive and prone to recurrence, underscoring the need for therapies that reduce surgical burden and improve long-term outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), developed for glycemic control in type 2 diabetes mellitus and more recently used for weight management in obesity, have demonstrated anti-inflammatory and immunomodulatory effects. Emerging evidence suggests that GLP1-RAs may benefit inflammatory skin conditions, including HS, by modulating cytokine profiles and immune cell function [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, population-level data evaluating the impact of GLP-1 RA therapy on HS disease course, especially surgical outcomes, remain limited.\u003c/p\u003e\u003cp\u003eWe performed a retrospective, propensity score\u0026ndash;matched cohort analysis using the TriNetX Global federated network to compare the incidence of HS-related surgical procedures in patients treated with GLP-1 RAs versus matched controls. Patients with HS were identified using the International Classification of Diseases (ICD) 10 code L73.2 and matched 1:1 on age, gender, race, and ethnicity, resulting in two balanced cohorts of 20,672 patients each. Exposure to GLP-1 RAs was determined through prescription records, and surgical outcomes were identified using Current Procedural Terminology (CPT) codes. Odds ratios (ORs) with 95% confidence intervals (CIs) were included to compare the incidence of surgical intervention between groups (see 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\u003eCase-Control Analysis of HS-Related Surgical Procedures in Patients Treated With GLP-1 RAs Versus Matched Controls.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome (CPT Code)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase (%)\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20,672)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControls (%)\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20,672)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u0026dagger;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u0026dagger;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.0 +/- 13.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.0 +/- 13.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.915\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,419 (55.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11,424 (55.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.961\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmerican Indian or Alaska Native\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164 (0.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e152 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.498\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16,938 (81.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16,957 (82.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNative Hawaiian or Other Pacific Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e159 (0.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Hispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14,226 (68.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14,239 (68.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.791\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,028 (9.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,012 (9.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack or African American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6,486 (31.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,499 (31.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,721 (18.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,706 (17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.848\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e376 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e371 (1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.854\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single (10060)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1174 (5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1352 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86 (0.79, 0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple (10061)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e491 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e582 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.84 (0.74, 0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0049*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcision of skin and subcutaneous tissue for hidradenitis, axillary (1003234)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e234 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e410 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56 (0.48, 0.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcision of skin and subcutaneous tissue for hidradenitis, inguinal (1003237)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e240 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.62 (0.51, 0.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical (1003240)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e215 (1.04%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51 (0.40, 0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001*​​\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e Reported data are after performing a propensity-matched analysis.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Statistically significant data indicated by \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSurgical interventions related to HS were significantly less common in patients treated with GLP-1 RAs compared to controls. Simple I\u0026amp;D was performed in 5.68% of GLP-1 RA users versus 6.54% of controls (OR\u0026thinsp;=\u0026thinsp;0.86, 95% CI: 0.79\u0026ndash;0.93), while complicated I\u0026amp;D occurred in 2.38% versus 2.82% (OR\u0026thinsp;=\u0026thinsp;0.84, 95% CI: 0.74\u0026ndash;0.95). Rates of WLE were also significantly lower in the GLP-1 RA group, including axillary excision (1.13% vs. 1.98%; OR\u0026thinsp;=\u0026thinsp;0.57, 95% CI: 0.48\u0026ndash;0.67), inguinal excision (0.73% vs. 1.16%; OR\u0026thinsp;=\u0026thinsp;0.62, 95% CI: 0.51\u0026ndash;0.76), and perineal or umbilical excision (0.53% vs. 1.04%; OR\u0026thinsp;=\u0026thinsp;0.51, 95% CI: 0.40\u0026ndash;0.64) (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur large, multicenter analysis demonstrates that treatment with GLP-1 RAs is associated with a significant reduction in the frequency of surgical interventions for patients with HS. The magnitude of effect was most pronounced for WLEs (i.e., perianal, perineal, and umbilical), where GLP-1 RA use was associated with nearly a 50% reduction in surgical burden (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Surgical management of HS, while often necessary, is associated with postoperative complications, prolonged recovery periods, and substantial healthcare costs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. By potentially reducing the frequency and necessity of surgical interventions, GLP-1 RA therapy may improve patient quality of life and decrease healthcare resource utilization.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMetabolic dysregulation, including obesity and insulin resistance, has been implicated in the pathophysiology of HS, with obesity being a well-established risk factor for increased disease severity and persistence [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. GLP-1 RAs, like liraglutide, improve glycemic control and induce weight loss by enhancing glucose-dependent insulin secretion and reducing appetite. Liraglutide has demonstrated anti-inflammatory properties via the suppression of tumor necrosis factor alpha (TNF-α), nuclear factor-kappa B (NF-κB), and other pro-inflammatory cytokines such as IL-17, IL-22, and IL-23, which are implicated in the pathophysiology of HS [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These anti-inflammatory properties, combined with demonstrated metabolic effects, position GLP-1 RA therapy as an effective disease-modifying strategy that may address underlying metabolic dysfunction, chronic systemic inflammation, and decrease disease severity [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent case series suggest similar findings and report clinical improvement in HS patients treated with GLP1-RAs, including reductions in lesion count, pain, and flare frequency [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe retrospective study design and reliance on administrative coding introduce potential limitations, including misclassification bias and residual confounding, despite propensity matching. Detailed clinical data on HS severity (i.e., Hurly stage), duration of GLP-1 RA therapy, adherence, and concomitant treatments were not available. Therefore, the ability to perform dose-response or temporal analyses was limited. Carbon dioxide (CO\u003csub\u003e2\u003c/sub\u003e) laser procedures were also excluded from analysis due to limitations in CPT coding specificity. Future studies should incorporate these interventions, as they are an important and expanding component of HS surgical care.\u003c/p\u003e\u003cp\u003eFurther research is needed to evaluate the cost-effectiveness of GLP-1 RAs. Surgical procedures, particularly WLEs, can be remittive for some patients, potentially offering long-term or permanent disease control. In contrast, GLP-1 RAs may require ongoing administration, which could result in substantial cumulative costs and may not induce remission. The optimal duration of GLP-1 RA therapy for HS also remains unclear as it is not yet known whether these agents are needed long-term to sustain benefit or if a finite course can achieve significant disease modification.\u003c/p\u003e\u003cp\u003eAdditionally, it is important to recognize that not all patients are candidates for or desire surgery due to its invasiveness, associated risks, and impact on quality of life. Some patients may elect to pursue less invasive medical management options. The availability of effective non-surgical therapies such as GLP-1 RAs may expand the range of treatment choices, supporting a more individualized and patient-centered approach to HS care. Therefore, future studies should assess the long-term efficacy and cost-benefit profile of GLP-1 RA therapy with respect to patient-reported outcomes and satisfaction across different management strategies.\u003c/p\u003e\u003cp\u003eOur findings support and extend prior studies by demonstrating, at population scale, that GLP-1 RA use is associated with a significantly reduced need for surgical interventions. This suggests symptomatic improvement and a measurable decrease in surgical disease burden, highlighting a possible disease-modifying effect of GLP-1 RA therapy in HS. Prospective, randomized controlled trials are needed to confirm these observational findings, elucidate the pathophysiologic mechanisms underlying GLP-1 RA efficacy in HS, and define optimal dosing and patient selection criteria. Additionally, investigating the synergistic effects of GLP-1 RAs with biologic medications such as adalimumab or secukinumab may further enhance therapeutic outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding sources:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Hamzavi has served as an advisory board member for AbbVie; a consultant for Boehringer Ingelheim, AVITA Medical, Galderma Laboratories LP, Incyte, Pfizer, and UCB; a principal investigator for AVITA, Bayer, Estee Lauder, Ferndale Laboratories, Incyte Corporation, Lenicura, L\u0026rsquo;Oreal, Pfizer, and Unigen; immediate past president of the HS Foundation; and a board member of the Global Vitiligo Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB approval status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was considered by our IRB to be non-human research and thus exempt from review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKS, SK, SG, KK, and RK assisted with data collection, analysis, and prepared the original draft of the manuscript. KP and IH contributed to reviewing and editing. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlikhan A, Sayed C, Alavi A et al (2019) North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol 81(1):76\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaad.2019.02.067\u003c/span\u003e\u003cspan address=\"10.1016/j.jaad.2019.02.067\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee YS, Jun HS (2016) Anti-Inflammatory Effects of GLP-1-Based Therapies beyond Glucose Control. Mediat Inflamm 2016(1):3094642. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2016/3094642\u003c/span\u003e\u003cspan address=\"10.1155/2016/3094642\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVidal SI, Menta N, Nussbaum D, Friedman A (2024) GLP-1 Receptor Agonists for the Dermatologist: Uses and Considerations. J Drugs Dermatol 23(11):1026\u0026ndash;1027\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDrucker DJ (2018) Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metabol 27(4):740\u0026ndash;756. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cmet.2018.03.001\u003c/span\u003e\u003cspan address=\"10.1016/j.cmet.2018.03.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarg A, Kirby JS, Lavian J, Lin G, Strunk A (2017) Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States. JAMA Dermatology 153(8):760\u0026ndash;764. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamadermatol.2017.0201\u003c/span\u003e\u003cspan address=\"10.1001/jamadermatol.2017.0201\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRames MM, Alavi A, Aghazadeh N (2025) GLP-1 Agonists in Patients with Hidradenitis Suppurativa: A Case Series. J Cutan Med Surg Published online Febr 18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/12034754251320045\u003c/span\u003e\u003cspan address=\"10.1177/12034754251320045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\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, glucagon-like peptide-1 receptor agonists, dermatologic surgery, disease modification, propensity score matching","lastPublishedDoi":"10.21203/rs.3.rs-7603854/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7603854/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Hidradenitis suppurativa (HS) is a chronic inflammatory disease marked by painful nodules, abscesses, and sinus tracts, often requiring interventions such as incision and drainage (I\u0026D) or wide local excision (WLE). These procedures, common in moderate to severe cases, are invasive and prone to recurrence, underscoring the need for therapies that reduce surgical burden. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exhibit anti-inflammatory and immunomodulatory properties, with emerging evidence suggesting potential benefits for HS. The objective was to evaluate the impact of GLP-1 RA therapy on surgical outcomes in patients with HS using population-level data. A retrospective, propensity score–matched cohort analysis was performed on TriNetX comparing rates of HS-related surgical procedures in patients treated with GLP-1 RAs versus matched controls. Patients were matched 1:1 on age, gender, race, and ethnicity, resulting in two balanced cohorts of 20,672 patients each. Exposure to GLP-1 RAs was determined through prescription records, and surgical outcomes were identified using CPT codes. Odds ratios with 95% confidence intervals were included to compare the incidence of surgical intervention between groups. Simple I\u0026D was performed in 5.68% of GLP-1 RA users versus 6.54% of controls, while complicated I\u0026D occurred in 2.38% versus 2.82%. Rates of WLE were also significantly lower in the GLP-1 RA group, including axillary excision, inguinal excision, and perineal or umbilical excision. GLP-1 RA use is associated with a significantly reduced need for surgical interventions, highlighting a possible disease-modifying effect in HS. While surgery may offer remission, it may not be suitable or preferred by all patients, and GLP-1 RAs may require ongoing use and incur long-term costs. Prospective trials are needed to confirm these findings, clarify cost-effectiveness, optimal duration, and patient selection, and to compare outcomes with surgical approaches.","manuscriptTitle":"GLP-1 Receptor Agonist Therapy and Surgical Procedure Rates in Hidradenitis Suppurativa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-23 11:49:20","doi":"10.21203/rs.3.rs-7603854/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-01T22:59:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T10:54:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251593346757920488542937377589869713592","date":"2026-01-11T09:56:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T21:01:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-13T17:44:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-13T17:43:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-09-13T00:22:28+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":"de5688b2-71cf-4ecc-8e4c-55babf695da7","owner":[],"postedDate":"November 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-12T23:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-23 11:49:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7603854","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7603854","identity":"rs-7603854","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}