Evaluating Factors Associated With Treatment Satisfaction in Hidradenitis Suppurativa


Tobacco smoking, depression, and increasing number of comorbidities were associated with reduced treatment satisfaction among patients with hidradenitis suppurativa.

Patients primarily treated by a dermatologist and those receiving biologic therapy were more likely to report satisfaction with treatment for hidradenitis suppurativa (HS), according to study findings published in British Journal of Dermatology.

HS is linked with a substantial quality of life burden among patients, with findings of the Global Survey Of Impact and Healthcare Needs (Global VOICE) project indicating that 23%, 30%, and 31% of patients experienced flare daily, weekly, or monthly, respectively. Despite nearly 50% of patients with HS reporting dissatisfaction with their medical treatment, factors related to adverse care management outcomes have not been explored.

“Treatment in HS remains the most fundamentally important gap in care for the disease state. To date, there is one regulatory approved treatment for moderate-to-severe HS, wherein about half of patients are expected to have approximately a 50% improvement from baseline count of inflammatory nodules and abscesses,” the study authors wrote.

“Information from patients with HS on factors influencing satisfaction with treatment may support patient-centred strategies to optimize outcomes.”

Researchers derived data from the cross-sectional Global VOICE survey to measure associations between treatment satisfaction and clinical and treatment-related characteristics. The questionnaire was administered to 27 institutions, mainly HS referral centers, in 14 countries from October 2017 to July 2018.

Fifty questions related to patient demographics, perspectives on diagnosis and care, pain and symptoms, life impact, comorbid conditions and treatment were part of the survey. The primary outcome investigated was patients’ self-reported overall satisfaction with their current treatments for HS, rated on a 5-point scale from “very dissatisfied” (1) to “very satisfied” (5).

Associations between treatment satisfaction and the following predictor variables were explored: age, sex, delay in HS diagnosis, body mass index (BMI), tobacco use (current, former, never), primary management of HS by a dermatologist (yes/no), depression, anxiety, number of comorbidities, treatment type, and flare frequency (every 6 months, every 3 months, monthly, weekly, daily).

Current treatment was classified as topical or injection only, nonbiologic systemic, biologic, or no medical treatment.

A total of 1418 patients with HS were included in the survey, in which a majority were European (55%) or North American (38%) and female (85%). Overall, 45% of participants reported being either dissatisfied or very dissatisfied with their current medical treatment.

After adjusting for potential covariates, findings showed that patients primarily treated by a dermatologist for HS were nearly twice as likely (odds ratio [OR], 1.99; 95% CI, 1.62–2.44; P < .001) to report being satisfied with current treatment vs those not primarily treated by a dermatologist.

Treatment with biologics was also associated with higher satisfaction (OR, 2.36, 95% CI, 1.74–3.19; P < .001) relative to treatment with nonbiologic systemic medications, as well as lower frequency of flares (every 6 months) vs higher frequency (3 months, monthly, weekly, or daily).

Conversely, tobacco smoking (OR, 0.78; 95% CI, 0.62–0.99; active vs never), depression (OR, 0.69; 95% CI, 0.54–0.87), and increasing number of comorbidities (OR, 0.88 per comorbidity; 95% CI, 0.81–0.96) were associated with lower treatment satisfaction.

Limitations of the analysis included its use of self-reported data and lack of data on disease severity.

“A number of factors appear to influence satisfaction with treatment among patients with HS…Awareness of these factors by physicians and patients may support partnered decision making, which may improve outcomes,” concluded the study authors.


Midgette B, Strunk A, Akilov O, et al. Factors associated with treatment satisfaction in patients with hidradenitis suppurativa: results from the Global VOICE project. Br J Dermatol. Published online July 30, 2022. doi:10.1111/bjd.21798

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