The social impact of hidradenitis suppurativa associated with poor QOL, and mental health burden

Patients with HS who reported feelings of stigma due to their condition had worse quality of life and higher levels of depression and social anxiety compared to those who did not report feelings of stigmatization.

.’s social impact hidradenitis HS may increase the burden of quality of life (QOL) and risk of adverse behavioral health outcomes in patients, according to study results published in Archives of dermatology research.

Hidradenitis suppurativa is characterized as a debilitating skin disease that can have an adverse effect on a patient’s QOL, even in mild presentation. Researchers have suggested that painful nodules, abscesses, and sinus tracts affecting patients with HS can cause a significant psychosocial burden.

In particular, feelings of stigmatization, defined as awareness of devaluation, denigration, or social rejection based on a physical sign or trait, are of great concern because they can lead to the patient feeling shame and isolation due to fears of negative reaction. .

“Although there are limited quantitative studies to assess feelings of stigmatization using an objective scale, feelings of stigmatization have been associated with being proportionately dependent on clinical stage and disease site,” the study authors said. Furthermore, the association between HS secondary stigma and its relationship to comorbid psychiatric conditions and the burden of HS is limited.

They conducted an observational study of 153 patients (n = 30 clinics; n = 123 PO) between June and September 2018 who received a clinical diagnosis of HS from the Atrium Health Wake Forest Baptist Dermatology Clinic within the past 5 years to evaluate stigma and its relationship to patient QOL. depression and social anxiety using objective tools. Of this group, 67 responses (response rate [RR]44%) (clinic, n = 27 [RR, 90%]; e, n = 40 [RR, 33%]).

Participants completed the Dermatology Life Quality Index (DLQI) to assess skin-related quality of life; Patient Health Questionnaire 9 (PHQ-9) to assess depression; The Brief Fear Negative Evaluation (BFNE) for Social Anxiety Assessment. Increased scores on the DLQI, PHQ-9, and BFNE are associated with worse QOL, and increased levels of depression, and social anxiety, respectively.

Participants also completed a modified version of the Feelings of Stigma (FoS) survey to measure stigma, which was scored on a scale from 0 (minimum stigma) to 155 (maximum stigma). Respondents were divided into two groups based on the mean FoS (72): high blot (72 or more) and low blot (<72).

The median age of the responding study group was 39 years, 57% of the patients were African American, and 90% were female. The median stigma score was 74, and the median score was 72. FoS showed a weak association (r) with PHQ-9 (r = 0.42) and moderately with DLQI (r = 0.68) and BFNE (r = 0.51).

The results indicated that participants in the high stigma group were more likely to have a worse quality of life (18.1), higher levels of depression (11.1), and higher social anxiety (30.1) than their low stigma counterparts (6.7, s <.001; 4.9, s <.001; 23.2, s < .001, respectively). No difference in disease severity was shown according to FoS.

The limited response rate between the cohort was cited as a possible limitation of the study results. Furthermore, although FoS is an objective measure of stigma, it was originally intended for patients with psoriasis.

The study authors concluded, “Participants who felt more stigmatized were more likely to have poorer quality of life, more social anxiety, and depression.” “A multidisciplinary, patient-centered focus on treating the physical and psychosocial aspects of HS may help reduce the burden of HS.”


Singh R, Kelly K, Senthelnathan A, Feldman SR, Picardo Rowe. Stigma, a social perception that may have a debilitating effect on HS patients: an observational study. Arch Dermatol Res. 2022; 1-4. doi: 10.1007/s00403-022-02412-5

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