Does Alexithymia Affect Patients with Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with substantial psychosocial burden. Alexithymia, characterized by difficulties in identifying and expressing emotions, has been increasingly recognized in chronic disorders. However, data in HS remain limited. This study aimed to assess the prevalence of alexithymia in HS and its relationship with clinical and psychosocial parameters.

This cross-sectional study included 123 consecutive adult HS patients. Disease severity was assessed using Hurley staging and the International Hidradenitis Suppurativa Severity Score System (IHS4). Alexithymia was evaluated with the Toronto Alexithymia Scale (TAS-20). Pain and pruritus were measured using the Numeric Rating Scale. Psychological burden was assessed with Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Hospital Anxiety and Depression Scale (HADS), illness acceptance was studied with Acceptance Illness Scale (AIS), while quality of life (QoL) was evaluated using Dermatology Life Quality Index (DLQI) and Hidradenitis Suppurativa Quality of Life (HiSQoL) questionnaire.

Alexithymia was identified in 13.8% of patients, while 22.0% presented intermediate levels. The mean TAS-20 score was 46.45 ± 12.75 points. Females showed higher difficulty in identifying feelings (p=0.025). No significant associations were found between total alexithymia scores and disease severity. However, the externally oriented thinking (EOT) domain was significantly higher in more severe disease. TAS-20 scores showed weak correlations with IHS4, pain, and pruritus. Stronger associations were observed with depressive symptoms, anxiety, impaired QoL, and poorer disease acceptance, particularly for the difficulty in identifying feelings domain.

Alexithymic traits affect a substantial proportion of HS patients and are primarily associated with psychosocial burden rather than objective disease severity. Assessment of alexithymia, especially its domains, may provide clinically relevant insights and support a more comprehensive, multidisciplinary approach to HS management.