Hidradenitis suppurativa publication trends from Latin America from 2009 to 2019: A bibliometric analysis.

Hidradenitis suppurativa (HS) disproportionately affects women and has phenotypic and epidemiologic differences across races and geographic regions.

However, a majority of influential HS literature originates from Europe and the United States.

Latin America is underrepresented in HS literature landscape: only 2% of all HS literature in the last decade originated from Latin America.

More studies on HS patients, including both women and men, in underrepresented regions are needed to better elucidate potential genetic, immunologic, and phenotypic differences in disease presentation and treatment response.

Dear Editors,

Hidradenitis suppurativa (HS) is a debilitating dermatosis that predominantly affects women in many world regions.[1] Despite phenotypic and epidemiologic differences that have been noted across geographic regions and races,[2] the majority of influential HS literature has originated from Europe and United States, similar to overall global publication productivity trends seen in dermatology.[3,4] Herein, our bibliometric analysis evaluates HS literature from Latin America over the past decade.

In August 2020, the PubMed database was systematically searched for HS articles between 2009 and 2019. Abstracts, proceedings reports, and errata were excluded. Articles were analyzed for authorship, country, study topic/design, and level of evidence (LoE) using the Oxford Centre for Evidence-Based Medicine guidelines and categorized as high (I–III) or low (IV–V) LoE.

One thousand five hundred twenty-two articles met inclusion criteria. Twenty-nine (1.9%) originated from Latin America (Supplementary Table S1 http://links.lww.com/IJWD/A3), of which 20 of 29 (69%) were published in the last 5 years. The majority were from Brazil (12/29, 41.4%) and Chile (11/29, 37.9%) (Fig. 1). There were more low LoE (13/29 [44.8%] than high LoE 9/29 [31%]) studies (Fig. 2). Latin America-based journals published 12 of 29 (41.4%) of the articles, of which Anais Brasileiros de Dermatologia of the Brazilian Society of Dermatology published the most (6/29, 20.7%).

Fig. 1.

Country of origin for publications from Latin America between 2009 and 2019.

Fig. 2.

Types of articles and topic of articles published in Latin America between 2009 and 2019.

Eight studies (27.6%) discussed diagnostics, specifically the utility of ultrasound imaging in HS. Dr. Ximena Wortsman contributed to all 8 and published the most articles overall. Eight articles (27.6%) discussed procedural interventions, examining surgery (4/8, 50%), photodynamic therapy (2/8, 25%), negative-pressure wound therapy (1/8, 12.5%), and CO2 laser (1/8, 12.5%). Four (13.8%) discussed presentation, including prepubertal and atypical HS. Three (10.3%) examined epidemiology, reporting female predominance of HS and associated comorbidities including obesity and smoking. One (3.4%) is a 2019 clinical practice guideline by the Brazilian Society for Dermatology to aid clinicians in diagnosis and management of HS.

Although Latin America represents <2% of the global HS literature in the past decade, its literature has grown over time. The predominance of case report/series highlights the need for higher LoE studies. The lack of randomized controlled trials is consistent with previous literature highlighting underrepresentation of certain geographic regions in HS randomized controlled trials.[5] The reported increased incidence of HS in female Latin American patients is similar to that seen in European and North American literature but differs from other regions, such as South Korea.[1]

The most published topic was imaging in HS. Dr. Wortsman’s contributions highlight the impact 1 individual can make in investigating a gap in this field. The second most common was procedural interventions, which may suggest a strong interest in procedural treatments in this region. Regional journals published >40% of Latin American HS papers, highlighting their pivotal role in disseminating literature from these regions. Strategies to increase HS research from Latin America include improved research funding, collaborations with industry partners to advance HS diagnostics and therapies globally, and increased avenues for international scholarly exchange. This study is limited by the search of only 1 database, PubMed.

Our study highlights Latin America’s underrepresentation in global HS literature. Encouraging increased HS research in underrepresented regions will help elucidate potential genetic, immunologic, and phenotypic differences in disease presentation and treatment response, improving patient outcomes globally.

Conflicts of interest

The authors made the following disclosures: J.L.H.: Board of Directors for the Hidradenitis Suppurativa Foundation, has served as a consultant for Boehringer Ingelheim, Novartis, and UCB, and has served as a consultant and speaker for AbbVie. V.Y.S: board of directors for the Hidradenitis Suppurativa Foundation (HSF), is a stock shareholder of Learn Health and has served as an advisory board member, investigator, speaker, and received research funding from Sanofi Genzyme, Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Incyte, Boehringer Ingelheim, Aristea Therapeutics, Menlo Therapeutics, Dermira, Burt’s Bees, Galderma, Kiniksa, UCB, Target-PharmaSolutions, Altus Lab/cQuell, MYOR, Polyfins Technology, GpSkin, and Skin Actives Scientific. T.S., J.S., A.M.T., S.A.: no conflicts of interest.

Funding

None.

Study approval

N/A.

Supplementary materials

Supplementary material associated with this article can be found at http://links.lww.com/IJWD/A3.