Does Hidradenitis Suppurativa Impact Quality of Life More Than Other Skin Conditions Like Eczema and Psoriasis?

🔍 Key Finding Hidradenitis suppurativa (HS) negatively impacts quality of life more significantly than psoriasis or atopic dermatitis, particularly among women and those with severe disease (Hurley stage 3), and is associated with lower employment rates. This highlights the need for increased awareness, psychosocial support, and targeted interventions for HS patients.

🔬 Methodology Overview

• Design: Cross-sectional case-control study
• Setting: Public hospital in Jeddah, Saudi Arabia
• Participants: 46 patients with Hidradenitis Suppurativa (HS) and 101 controls with psoriasis or atopic dermatitis (1:2 case-control ratio).
• Data Collection: Medical record review and telephone-administered questionnaires (Dermatology Life Quality Index [DLQI], Rosenberg Self-Esteem Scale [RSES], Hospital Anxiety and Depression Scale [HADS], and a Hurley stage assessment survey).
• Data Analysis: Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, independent samples t-tests, and Spearman correlation coefficient.
• Study Period: January 2016 - December 2019.

📊 Results

• HS significantly impacts quality of life: Patients with HS had significantly higher Dermatology Life Quality Index (DLQI) scores (9.5 ± 6.92) and depression scores compared to controls with eczema or psoriasis (DLQI: 5.82 ± 6.03 and 7.23 ± 6.92, respectively).
• Women more affected: Women with HS reported significantly higher anxiety (6.14) and depression (5.54) scores compared to men with HS (4.41 and 3.8, respectively).
• Disease severity correlates with QoL: HS patients with Hurley stage 3 had significantly higher DLQI scores (15.11) than those with Hurley stages 1 (6.85) and 2 (9.81).
• Lower employment rate in HS: Only 30.4% of HS patients were employed, significantly lower than the 39.6% employment rate in the control group.
• Later age of diagnosis in HS: The mean age of HS diagnosis was significantly higher (28.76 ± 8.79 years) compared to the control group (20.1 ± 8.28 years).
• Shorter disease duration in HS at study entry: HS patients had a shorter mean disease duration (3.3 ± 4.38 years) at the time of the study compared to controls (6.39 ± 7.42 years). This may be due to the later age of diagnosis in HS.

💡 Clinical Impact Hidradenitis suppurativa (HS) negatively impacts quality of life and psychosocial well-being more significantly than other inflammatory skin diseases like psoriasis and eczema, particularly for women and those with severe disease (Hurley stage 3). This highlights the need for increased dermatologist awareness of HS psychosocial impact, earlier diagnosis, and integration of mental health support (psychiatric referrals, support groups) into HS management.

🤔 Limitations

• Small sample size.
• Single-center study.
• Lack of a healthy control group.
• Use of controls with other dermatological diseases.
• Potential for misdiagnosis and delayed diagnosis of HS.

✨ What It Means For You Doctors should be aware that hidradenitis suppurativa (HS) has a greater negative psychosocial impact and lower employment rates compared to other inflammatory skin diseases like psoriasis and atopic dermatitis, especially in women and those with more severe disease (Hurley stage 3). This necessitates increased attention to the psychological aspects of HS, including potential referral to mental health professionals and the development of support systems. Additionally, earlier diagnosis and intervention are crucial to mitigate the long-term psychosocial effects and improve quality of life for HS patients.

Reference AlSiyoufi A, AlMohaimeed S, AlSiyoufi S, Salah L. Psychosocial Implications and Quality of Life in Patients with Hidradenitis Suppurativa Compared to Those With Atopic Dermatitis and Psoriasis: a Cross-sectional Case-control Study. Dermatol Pract Concept. 2023;13(2):e2023076. https://doi.org/10.5826/dpc.1302a76