Pain and Late Onset of Hidradenitis Suppurativa May Affect Employment, Educational Level

Inactive occupational status and low educational level were associated with pain, late disease onset, and greater number of affected areas in patients with hidradenitis suppurativa.

Certain disease-specific factors may affect educational level and occupational status in patients with hidradenitis suppurativa (HS), according to study findings published in Actas Dermo-Sifiliograficas.

As a chronic, inflammatory, and relapsing skin disease, HS is a painful condition associated with physical and psychiatric symptoms. The economical impact of the disease has also been demonstrated, with prior research showing that patients with HS have significantly lower income growth and a lower annual income compared with the general population.

“Many patients experience embarrassment, shame, and social isolation because of their HS. It is then not surprising that HS could have a negative impact on educational level and labor activity,” said the study authors. “Some studies mentioned the negative impact of HS on daily activity, but none assessed the negative impact of HS on patients' careers.”

They conducted a cross-sectional analysis of patients with HS seen at a tertiary hospital in Badalona, Spain, between September 2017 and September 2018, to assess whether any disease-specific variables influenced occupational status and educational level.

The study cohort participated in the European Registry of HS, a standardized questionnaire designed by the European HS Foundation, with the following variables examined:

  • Occupational status:  “active” occupational group included employees or students and the “inactive” group included those unemployed, on sick leave (permanent or temporary), or with a disability
  • Educational level: nonuniversity studies (primary or high school and vocational school) and university studies (divided into less than 4 years or 4 years and more)
  • Independent variables: sex, age, body mass index (BMI), civil status, comorbidities (depression, pilonidal sinus, metabolic diseases, severe acne, arthritis, polycystic ovary, psoriasis, or inflammatory bowel disease), smoking history, and alcohol consumption
  • Disease-relative variables: age at HS onset, diagnostic delay, dermatology life quality index (DLQI; 0-1 no effect, 21-30 extreme effect), number of affected areas by HS (1, 2, or > 3), work absences due to HS, any effect of HS on career, HS concerns scale (VAS, 1-10), previous year outbreaks, painful days, pain level (VAS, 1-10), suppuration scale (VAS, 1-10), and impact on sleep by HS (VAS, 1-10) during the previous month

Ninety-eight patients with HS (median [IQR] age, 39.7 [30.1-47.2] years; median age of onset of HS, 19 [15.0-27.7] years; median delay in HS diagnosis, 8 [3-17]years; 65.3% female) were included in the study. Overall, 70.1% were overweight or obese, 79.4% had at least 1 comorbidity, and 23.7%, 21.5%, and 9.7% had moderate, severe, and extreme HS severity according to the DLQI, respectively.

Moreover, 23.1% and 76.8% of patients were included in the university and nonuniversity studies group, respectively, and 63.3% were employed or students.

Compared with patients of the university studies group, those of the nonuniversity group more frequently reported 3 affected areas (22.5% vs 4.8%; P = .049), a mean (SD) higher number of painful days (8.5 [8.8] vs 4.6 [4.8]; P = .048), and a higher score on the VAS scale (6.7 [2.8] vs 5.0 [3.3]; P = .031).

Patients from the inactive group showed a significantly increased mean number of painful days (11.2 [10.4] vs 5.7 [6.2]; P = .004), greater incidence of depression (61.3% vs 27.4%; P = .002), and a higher mean BMI (32.3 [9.1] vs 28.4 [6.4]; P = .016) compared with the active group. Late disease onset was found to be significantly associated with being in the inactive vs active group (26.7% vs 6.5%; P = .026).

No significant differences between severity scales of HS and educational level or occupational status were found.

Researchers concluded that physicians have to take into account the significant relation shown regarding poor pain control with lower educational level and inactive occupational status since it could be a modifiable variable of the disease. Limitations of the analysis included its cross-sectional and single-center study design.


Barboza-Guadagnini L, Podlipnik S, Fuertes I, Morgado-Carrasco D, Bassas-Vila J. Pain and late-onset of hidradenitis suppurativa can have a negative influence on occupational status and educational level. A cross-sectional study. Actas Dermosifiliogr (Engl Ed). Published online August 27, 2022. doi:10.1016/

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