The Psychosocial Impact of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a recurrent, chronic inflammatory disorder of the hair follicle predominantly localized to the axillae, groin, and inframammary regions of the skin (Figure). The disease is characterized by painful inflammatory nodules and abscesses that can eventually result in sinus tract formation, and scarring.1

Quality of Life Impact
Patients with this debilitating disease often socially isolate themselves, and report feelings of low self-worth and depression. Much time is spent adapting to life with HS, as patients alter clothing choices and adopt regimented hygiene routines in an effort to prevent disease exacerbations. Patients experience limitations in completing activities of daily living due to the immense pain associated with inflamed lesions.2 Purulent, malodorous discharge at disease sites may trigger embarrassment, self-consciousness, and isolation.

HS reduces quality of life, especially in those with disease in exposed areas.2 This quality of life impact may be attributed to the societal stigmatization, pain, and morbidity associated with the condition. In a study assessing depression incidence in patients with HS, 38.6% of patients had depression as measured by the Hospital Anxiety and Depression Scale compared with 2.4% in healthy controls. There was a statistically significant positive correlation between HS severity and depression scores.3 HS can have a significant impact on social interactions and a patient’s quality of life4,5—worse than other skin disorders such as alopecia, atopic dermatitis, and facial vascular anomalies.6,7 Irritability, depressed mood, embarrassment, fear of social stigmatization, and sexual distress are prevalent in patients with HS and can reduce patients’ quality of life.3

Timely Assessment
The psychosocial impact of the disease should be addressed aggressively due to the correlation between HS and mental illness (depression). Careful assessment of a patient’s psychosocial standing through patient interviews and observation is important.

Health care providers may opt to formally examine a patient’s mental status by considering a patient’s appearance, motor, speech, affect, thought content, thought process, intellect, and insight. Although formal mental health examinations may not be absolutely necessary in all patients, some form of mental health screening may be appropriate.

Support
Advocacy organizations such as the Hidradenitis Suppurativa Foundation promote HS education and support research aimed at decreasing the burden of disease. Online support forums serve as platforms for patients to share their experiences and support one other. Patient participation in these groups may be encouraged and incorporated into the discussion of the treatment plan. A sense of community in this patient population may serve to improve patients’ quality of life and reduce the psychosocial impact of the disease.

 

Ms Onikoyi is a third-year medical student at Touro College of Osteopathic Medicine, a division of Touro College in New York, NY.
Dr Cardwell is the dermatology clinical research fellow at Wake Forest University Department of Dermatology Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
Dr Huang is an assistant professor and residency program director in the Department of Dermatology at Wake Forest University School of Medicine in Winston-Salem, NC.

Disclosure: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol-Myers Squibb. Dr Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol-Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. He is owner of www.DrScore.com and a founder of Causa Research.

Ms Onikoyi and Drs Cardwell and Huang report no relevant financial relationships.

References
1. Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: an update. J Am Acad Dermatol. 2015;73(5 suppl 1):S8-S11.
2. Esmann S, Jemec GB. Psychosocial impact of hidradenitis suppurativa: a qualitative study. Acta Derm Venereol. 2011;91(3):328-332.
3. Kurek A, Johanne Peters EM, Sabat R, Sterry W, Schneider-Burrus S. Depression is a frequent co-morbidity in patients with acne inversa. J Dtsch Dermatol Ges. 2013;11(8):743-749.
4. Onderdijk AJ, van der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2013;27(4):473-478.
5. Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90(3):264-268.
6. Dufour DN, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgrad Med J. 2014;90(1062):216-221.
7. von der Werth JM, Jemec GB. Morbidity in patients with hidradenitis suppurativa. Br J Dermatol. 2001;144(4):809-813.