Study Details Effects of Hidradenitis Suppurativa on QOL

Hidradenitis suppurativa (HS), also known as acne inversa, impairs quality of life (QOL) more than many other dermatological conditions, a new study shows.

Approximately 60% of HS patients reported very or extremely large QoL impairment, according to the study published in Frontiers in Medicine. The degree of disturbance correlated with the severity of changes to the skin, blood leucocyte count, and particularly with presence in the anogenital region as well as the presence of nodules and fistulas.

HS is a chronically relapsing inflammatory disease with characteristic alterations in skinfolds. It is estimated to affect about 1% of the population, generally occurring in the second and third decade of life. It can also affect the inner thighs, perineal area, and the lower boundary where the breast and chest meet. It causes painful bumps under the skin in the hair roots near the sweat glands that can become infected. Inflammation can be destructive to the skin and lead to scarring.

HS is frequently associated with both spondyloarthritis and metabolic alterations, which increase the risk of cardiovascular disease and reduces life expectancy, the authors said.

The study involved 462 patients suffering from HS who visited University Hospital Charité in Berlin from 2012 to 2017. It showed that QOL important was also associated with specific comorbidities, including obesity and back pain, but not with family history of HS. QOL analysis was based on the Dermatology Life Quality Index, with scores ranging from 0 (no impairment) to 30 (maximum impairment), with 10 indicating being severely affected.

The average score of all HS patients was 13.18 (standard deviation, 0.37). A very large impairment (between 10 and 20) was reported by 40.3% of patients, and 20.1% reported an extremely large impairment (above 20). Questions focusing on symptoms like pain, soreness, stinging, itching, embarrassment, or restrictions in self-consciousness produced the highest values of impairment.

The level of impairment was significantly worse compared to patients with other chronic skin diseases including alopecia areata, acne vulgaris, vitiligo, atopic eczema, psoriasis vulgaris, and nonmelanoma cancer, the authors said. The presence of soreness and pain, as well as embarrassment, seem to be crucial contributors to lower QOL. Being affected in the anal and genital regions also showed a substantial negative impact on QOL, likely due to psychological effects in addition to pain, malodorous secretion, and limited mobility.

There were no differences between patients with small to moderate vs. large QOL impairment regarding having undergone resection surgery or antibiotic treatment, suggesting these classical treatment options do not lead to long-lasting QOL improvement.

The study found a significant association between QOL and body mass index (r_s = 0.167; P = .000), as well as between QOL and waist circumference (r_s = 0.158; P = .002). But no correlation was found in relation to patients’ age, disease duration, family history, or gender.

The authors said the findings support the necessity of prescribing anti–tumor necrosis factors. Adalimumab (Humira) and its biosimilars are approved for moderate to severe HS and have been demonstrated to improve QOL in trials and clinical practice.

Reference

Schneider-Burrus, Tsaousi A, Barbus S, et al. Features associated with quality of life impairment in hidradenitis suppurativa patients. Front Med (2021);8: 538. doi:10.3389/fmed.2021.676241