Hidradenitis Suppurativa

Abstract

PsychologyHidradenitis causes profound quality of life issues. This is due to chronic pain, odor, drainage, and illness. The result is days of work lost, low self-confidence, impaired sexual health, and even depression in some patients. Most of the disability of HS stems from the soreness and pain of the lesions [9]. A study by Matusiak et al. revealed that of the 30 employed patients, 58.1% had reported absence from work caused by HS, and during the 2 year follow up period, 10% were let go due to the frequency of their absences [10].Of particular importance, it was demonstrated that patients with HS suffer more sexual dysfunction compared to age, gender, and BMI matched controls [1]. Interestingly, it was found that women report greater sexual distress than men with HS of similar severity [1]. This may indicate that female patients with hidradenitis should be screened more closely for sexual dysfunction [1].Additionally, a survey-based study by Von Der Werth and Jemec found that hidradenitis led to lower quality of life scores than other chronic skin conditions such as psoriasis and acne [9]. Depression is more prevalent in sufferers of HS as well, Vazquez et al. found that over 40% of patients with HS had a diagnosis of depression [1,11]. Thus, it would be prudent for physicians to have a lower threshold when considering referral for psychological evaluation. Overall, improvements in management of this disease would likely relieve many of these psychological sequelae. Associated FactorsAlthough the precise etiology of HS remains unclear, there are a number of associated factors that have been consistently described. Many of these pre-disposing factors have insufficient or inconclusive evidence to support them. Of the factors that are well-established associations, strong evidence to explain causation remains lacking.There is a well-recognized association between cigarette smoking and HS [1]. Cross-sectional analyses have demonstrated a strong epidemiologic correlation, with study populations reporting from 70% to as high as 90% of disease sufferers being documented smokers. Some studies have demonstrated remission of disease with smoking cessation, while others show decreased rates of recurrence of disease after surgical resection with concomitant smoking cessation post-operatively.The role of sex hormones has been extensively reported but a clear consensus has not been reached on this topic. Evidence of hormonal