Social impact of hidradenitis suppurativa associated with impaired quality of life and mental health burden

The social impact of hidradenitis suppurativa (HS) may increase the burden of quality of life (QOL) and the risk of adverse behavioral health effects in patients, according to the results of a study published in Dermatological Research Archives.

HS is characterized as a debilitating skin disease that can negatively impact the patient’s quality of life, even in mild presentation. The painful nodules, abscesses and sinus tracts that affect patients with HS can lead to a significant psychosocial burden, the researchers noted.

In particular, feelings of stigma, defined as the awareness of social worthlessness, discredit or disapproval based on a brand or physical attribute, are of particular concern as they can lead to feelings of shame. and isolation in the patient due to fear of a negative reaction.

“Although there are limited quantitative studies assessing feelings of stigma using an objective measure, feelings of stigma have been associated as being proportionally dependent on clinical stage and location of disease,” said the authors of the study. “Furthermore, the association between secondary HS stigma and its relationship to psychiatric comorbidities and HS burden is limited.”

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

Participants completed the Dermatologic Quality of Life Index (DLQI) to assess skin-related quality of life; Patient Health Questionnaire 9 (PHQ-9), to assess depression; and Brief Fear of Negative Evaluation (BFNE), to assess social anxiety. Increasing scores on the DLQI, PHQ-9 and BFNE are correlated with poorer quality of life, increasing levels of depression and social anxiety, respectively.

Participants also completed an adapted version of the Feelings of Stigma (FoS) survey to measure stigma, which is scored on a range of 0 (minimum stigma) to 155 (maximum stigma). Respondents were divided into 2 groups based on median FoS (72): high stigma (72 or more) and low stigma (less than 72).

The study cohort of respondents had a mean age of 39 years, 57% were African American patients, and 90% were female patients. The mean stigma score was 74 and the median score was 72. FoS was shown to correlate weakly (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 lower quality of life (18.1), higher levels of depression (11.1) and higher social anxiety (30.1 ) compared to their low-stigma counterparts (6.7, P <0.001; 4.9, P <0.001; 23.2, P < 0.001, respectively). No difference in disease severity was shown according to FoS.

The limited response rate among the cohort was cited as a potential limitation of the study results. Additionally, although the FoS is a validated objective measure of stigma, it was originally intended for patients with psoriasis.

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

Reference

Singh R, Kelly KA, Senthilnathan A, Feldman SR, Pichardo RO. Stigma, a social perception that can have a debilitating impact on patients with hidradenitis suppurativa: an observational study. Arc Dermatol Res. 2022; 1-4. doi:10.1007/s00403-022-02412-5