Female Patients with HS Face Disproportionate Disease-Related Limitations

Female patients with hidradenitis suppurativa (HS) report increased pain-related issues with functional limitations and day to day activities compared to males, new findings suggest, and this may result from an underestimation of pain or several other factors.1

These recent findings were the result of a population-based, cross-sectional analysis led by Paige Kingston, MD, from Olive View-UCLA Medical Center in Los Angeles. Kingston and her team of investigators noted that prior data did exist on gender differences related to HS impacts on quality of life, highlighting a systematic review suggesting as much.2

Kingston et al. added that there is less research looking at distinctions between genders in terms of pain and its relationship with HS.

“Pain can make everyday tasks, such as sitting, walking or moving one's arms, painful or unbearable,” Kingston and colleagues wrote. “These physical limitations can negatively impact a patient's employment, education or relationships…This study compares differences in pain interference with daily activities and functional impairment between male and female patients with HS in the United States.”1

Trial Design and Findings

The investigators looked into pain interference with one’s day to day activities through inquiries to respondents how much their pain had affected normal work performance abilities within and outside the home over the prior 4-week timespan.

The research team assessed participants’ functional limitations through questions regarding specific difficulties, including climbing stairs, walking, holding onto objects, lifting, reaching overhead, stooping, bending, or standing for longer time periods. This analysis involved an assessment of data drawn from the 2002–2015 and 2018 Medical Expenditure Panel Survey (MEPS), with Kingston’s team implementing a cross-sectional and population-based format.

The team utilized multivariable logistic and linear regression analyses for the purposes of examining a connection between gender and both functional issues and pain interference. They also controlled for such factors as patient ancestry, age, ethnicity, insurance coverage, attainment of education, level of income, and various types of medical comorbidities.

There were 1,651,889 individuals with diagnoses of HS involved in this study, with 609,542 being reported as male and 1,042,347 as female. The investigative team concluded that female subjects reported far greater interference in activity related to pain in their daily lives as opposed to men (β = 0.49, 95% CI 0.25–0.73, P = .001).

The investigators also reported that females were almost 3 times more likely than those identifying as males to have functional impairments of some kind (adjusted odds ratio [aOR] 2.70, 95% CI 2.28–3.21, P < .001). The team highlighted that these data on gender differences underscore the value of recognizing such distinctions in the experience and impact of this skin disease on patients’ quality of life.

The researchers went on to note various factors which may provide some explanation for these disparities. They cited anatomical differences in lesion location as a potential factor, noting that women are more likely than men to report lesions in anterior areas of the body, while males tend to report posterior lesions.

The research team added that sensitive areas, including the breast and groin regions, are places in which lesions are reported to be more common in females. These may exacerbate any functional impairments.

The study also highlighted that pain reported by women is often underestimated and undertreated within medical settings, noting that this may lead to levels of pain and problems with daily life that are increased. The team specifically added that 60% of women who have HS report peri-menstrual flares, potentially contributing to rises in levels of disease-related pain.

“There are several limitations to the current study,” they wrote. “The MEPS does not capture data regarding HS lesion type or disease severity. Furthermore, data regarding quantitative pain severity was not available.”1

References

1. Kingston, P., Peterson, H., Lee, K., Huang, M.Y., Yee, D., Korouri, E. and Armstrong, A.W. (2025), Gender differences in pain interference with daily activities and functional impairment among patients with hidradenitis suppurativa: A population-based study in the United States. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20518.
2. Yee D, Collier EK, Atluri S, Jaros J, Shi VY, Hsiao JL. Gender differences in sexual health impairment in hidradenitis suppurativa: a systematic review. Int J Womens Dermatol. 2020; 7(3): 259–264. https://doi.org/10.1016/j.ijwd.2020.10.010.