The impact of hidradenitis suppurativa on general health is higher than that of hypertension, congestive heart failure, type 2 diabetes, myocardial infarction and depression

TY - JOUR

T1 - The impact of hidradenitis suppurativa on general health is higher than that of hypertension, congestive heart failure, type 2 diabetes, myocardial infarction and depression

AU - Sampogna, F.

AU - Fania, L.

AU - Mazzanti, C.

AU - Pallotta, S.

AU - Panebianco, A.

AU - Mastroeni, S.

AU - Didona, B.

AU - Abeni, D.

N1 - Funding Information: Quality of life (QoL) in patients with hidradenitis suppurativa (HS) is severely impaired. Such impairment may exceed that of other burdensome skin diseases, such as psoriasis, neurofibromatosis 1, chronic urticaria and atopic dermatitis. It was recently shown, reviewing data from different studies, that the impact of HS was comparable to that of cardiovascular diseases, chronic obstructive pulmonary disease or diabetes mellitus. The aim of this cross-sectional study was to compare the impact of HS to that of chronic non-dermatological conditions, using the MOS 36-item Short Form questionnaire (SF-36), a patient-reported measure of health status. This instrument includes eight dimensions, four concerning the physical domain and four the mental domain. Lower scores indicate a worse health status. Three hundred and five HS consecutive patients aged 16?years or more were recruited between 2016 and 2019. Among them, 62.6% were women, and the mean age was 32.1 (standard deviation?=?12.4) years. The International HS Severity Score System (IHS4) was?<?11 in 49.5% of patients and 11 or more in 50.5%. The mean scores of the single dimensions of the SF-36 in HS patients were compared with the U.S. normative scores for three, mutually exclusive groups of conditions: minor medical, defined as ?uncomplicated chronic medical conditions?; severe medical as ?advanced or complicated chronic medical conditions?; and psychiatric as ?either current depressive symptoms or disorder but no chronic medical condition?. Moreover, HS scores were compared with U.S. normative scores for specific conditions, such as hypertension, congestive heart failure, type 2 diabetes, recent acute myocardial infarction and depression. Compared with medical and psychiatric conditions (Fig.), HS patients had the lowest score for bodily pain (BP), and scores in the mental dimensions were very similar to those of patients with psychiatric conditions. Also compared with specific conditions (Fig.), HS patients reported the lowest scores for BP and in general for physical health, except for some scales in patients with congestive heart failure. Mental component scores were very similar to those of patients with depression. Even for mild?moderate disease severity (Fig.?S1, Supporting Information), BP had the lowest score and mental scale scores were very similar to those of depression. In two previous studies, the SF-36 was used to evaluate general health in patients with HS. However, in one study the scores were compared only with those of the normative French population and neurofibromatosis 1. In the second, scores were compared exclusively within the three different Hurley stages. Our results highlight the heavy physical burden in HS patients and thus the need of pain management. In some cases, access to consultations with a pain specialist may be warranted. The impact of HS on mental health is also noteworthy. In previous studies, as well as in a recent systematic review, it has been shown that HS was associated with depression and anxiety, and even with an increased suicide risk. It must be noted that, in our study population, even when the disease was clinically ?mild/moderate? according to the IHS4 severity scale, BP scores were the worst compared to patients with either medical or psychiatric conditions, and the mental health component was very similar to psychiatric conditions. Our observations have two main implications: first, the severity of dermatological conditions such as HS or psoriasis cannot be underestimated simply because they are considered as non-directly life-threatening, and thus, second, the classical measures of outcome (e.g. mortality) currently used in programmes intended to evaluate appropriateness and effectiveness of health care may not be the most appropriate for severe chronic dermatological conditions such as HS. Authors were partially supported by the ?Progetto Ricerca Corrente 2017?2019? of the Italian Ministry of Health, Rome, Italy. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/8/1

Y1 - 2020/8/1

UR - http://www.scopus.com/inward/record.url?scp=85082341783&partnerID=8YFLogxK

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U2 - 10.1111/jdv.16290

DO - 10.1111/jdv.16290

M3 - Letter

C2 - 32043666

AN - SCOPUS:85082341783

SN - 0926-9959

VL - 34

SP - e386-e388

JO - Journal of the European Academy of Dermatology and Venereology

JF - Journal of the European Academy of Dermatology and Venereology

IS - 8

ER -