Profound consequences of hidradenitis suppurativa: a review

Hidradenitis suppurativa (HS) influences patients' lives in many ways. The most troublesome symptom of HS is chronic pain, of mild-to-moderate intensity, which is reported by almost all patients. With reference to psychosocial evaluation, HS appears to be a highly debilitating disease. The major factors influencing patients' well-being are disease severity, the number of flares or affected skin areas, and the lesion location. The mean Dermatology Life Quality Index scores of 8·3-12·7 points obtained among patients with HS are typical for severe dermatoses, which have a large impact on patients' quality of life (QoL). HS not only affects skin-related QoL issues, but also has a profound impact on general QoL measures - it causes substantial deterioration of both physical and mental health. Considering the impaired QoL due to HS and HS-associated, nonpsychiatric comorbidities, it is not surprising that patients with HS experience psychological disturbances. In both observational and registry studies, depression and anxiety were significantly related to HS. The prevalences were estimated as 1·6-42·9% and 0·8-3·9%, respectively. HS was also linked to feelings of loneliness and stigmatization. Moreover, these patients have a significantly increased suicide risk (hazard ratio 2·42). HS, with its frequent involvement of the genital area, causes a pronounced impairment of sex life (66·7% of patients with HS reported sexual difficulties). Finally, HS causes significant financial burden, not only through the costs of healthcare, but also due to a substantial impact on patients' professional careers. This is a reason for absenteeism from work for approximately half of patients, and a relatively high unemployment rate.