Hidradenitis Suppurativa-Related Stigmatization Linked to Duration, Itch, Depression

Individuals with hidradenitis suppurativa (HS) experience heavy stigmatization associated with itch, duration of their disease, and depression, according to recent findings, and a comprehensive screening for psychosocial comorbidity may be necessary.¹

These findings on patients with HS in Europe were the result of new research into the psychosocial effects of the skin disease, given the known stigmatization faced by many resulting from the condition’s physical appearance and its impact on quality of life.

Servando E. Marron—from the department of dermatology at the University Hospital Miguel Servet in Zaragoza, Spain—led the investigative team that authored this analysis. Marron et al. noted that variations in health-associated and disease-specific elements associated with HS, as well as psychological factors like stigmatization, may result in a heavy burden exceeding the disease’s severity even.²

“The present study aimed to investigate the association between stigmatization, depression, anxiety, and health- and disease-related variables, specifically among patients with HS across Europe,” Marron and colleagues wrote.¹

Analysis Design and Details

The study’s principal aim was to assess the effects of stigmatization as well as body image concerns among those with conditions like HS. The research team carried out this observational, multicenter, cross-sectional study across 17 European countries, conducting the analyses specifically from September 2017 - December 2019.

Those who took part as subjects were dermatology patients who had been recruited by the team from 22 outpatient clinics, with participants qualifying provided they were 18 years of age and fluent in reading and writing their local language. The investigators gathered responses from a targeted sample of 250 participants per site.

This analysis focused specifically on those who had an HS diagnosis that had been based on an ICD-10 classification. Subjects were asked about their demographic information such as marital status, gender, age, educational attainment, and general health.

For evaluations of general health, the research team used the EuroQol 5-D visual analog scale (EQ-VAS), an assessment rating one’s health on a scale from 0 (worst imaginable) to 100 (best imaginable). The team also gathered BMI data and recorded physical comorbidities.
Dermatologists would rate the severity of each participant’s HS as being mild, moderate, or severe. During the analysis, the investigative team documented frequency of flare-ups, disease location, duration, and any itch experienced in the prior 24 hours.

The team used the 21-item Perceived Stigmatization Questionnaire (PSQ) to evaluate subjects’ stigmatization. This questionnaire maintains 3 subscales which look at confused/staring behavior, the lack of friendly behavior, and generally hostile behavior.

Findings on HS

The researchers noted that among the 5,487 dermatology patients they assessed, 2.6% had been given a diagnosis of HS. In their final analysis, data from 135 subjects who had filled out the PSQ—70.1% of whom were female and the mean age of which was 38.2 years—were included.

In their findings, the investigators found that there were significant levels of stigmatization reported among those with HS. In the linear regression models, the team concluded that there were links between disease duration, stigmatization, and presence of itch.

The research team also reported an association between depression and higher scores on the PSQ’s ‘confused/staring behavior’ subscale. They added that poorer general health showed an inverse correlation with scores on the “absence of friendly behavior” subscale.

The investigators also found that there was a positive link between depression and the ‘hostile behavior’ subscale.

“In conclusion, the results of our study show that patients with HS experience significantly more stigmatization than controls and that feelings of stigmatization are associated with the duration of the skin disease and the presence of itch,” they wrote. “Furthermore, depression is a predictor of confused/staring and hostile behavior, and general health status is inversely related to the absence of friendly behavior.”¹

References

1. ^{Marron, S.E., Gracia-Cazaña, T., Tomas-Aragones, L, et al (2024). Stigmatization and perceived health status in patients with hidradenitis suppurativa: an observational multicenter study in Europe. Int J Dermatol. https://doi.org/10.1111/ijd.17569}
2. ^{Ooi XT, Choi E, Han H, Ahmad H, Patwardhan KR, Chandran NS. The psychosocial burden of hidradenitis suppurativa in Singapore. JAAD Int. 2022; 10: 89–94.}