Patients with hidradenitis suppurativa may suffer from neuropathic pain: A Finnish multicenter study

Huilaja, Laura; Hirvonen, Mirkka J.; Lipitsä, Tiina; Vihervaara, Armi; Harvima, Rauno J.; Sintonen, Harri; Kouri, Jukka Pekka; Ranta, Martta; Pasternack, Rafael

doi:10.1016/j.jaad.2019.11.016

Cited by 17 publications

(28 citation statements)

References 6 publications

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“…Other reasons for exclusion along with the flow chart are shown in Figure 1 . Finally, 17 studies, representing 4929 patients with HS, met the eligible criteria and were included and fully reviewed [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

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The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis

Montero‐Vílchez

Díaz-Calvillo

Rodríguez-Pozo

et al. 2021

IJERPH

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Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating inflammatory skin disease of the hair follicle that usually presents as painful, deep-seated inflamed lesions in the apocrine gland-bearing areas of the body. HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour and suppuration, which may impair patients’ quality of life (QoL). Although HS patients frequently experience these signs and symptoms, they are only occasionally assessed by clinicians and, unexpectedly, the scientific evidence available is limited and heterogeneous. The aim of this study is to summarize the evidence regarding the impact of HS signs and symptoms on QoL to serve as a basis for future research and help clinicians to consider them in the daily care of HS patients. A systematic review and meta-analysis were conducted following PRISMA Guidelines. The following search algorithm was used: (hidradenitis or “acne inversa”) and (pain or itch or odour or malodour or suppuration or oozing or drainage) and (“quality of life”). The literature search identified 836 references, 17 of them met the eligible criteria and were included for analysis, representing 4929 HS patients. Mean age of the participants was 36.28 years and there was a predominance of female sex among study participants. The BMI of the population was in the range of over-weight and about two out five patients were active smokers. Studies included patients with mild to moderate HS, with a mean disease duration of 13.69 years. The HS signs and symptoms assessed were pain, pruritus, malodour and suppuration. Overall, the higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions including sexual distress, anxiety, depression and sleep. The most frequently employed tool to assess QoL was the Dermatology Life Quality Index (DLQI). DLQI was used in 52.9% of the studies (9/17) with a mean value of 10.70 (2.16 SD). The scores employed to assess signs and symptoms severity were subjective and varied between studies, being the numerical rating scale (NRS) for each of the most used symptoms. The mean NRS value for pain was 3.99 and the mean NRS for pruritus was 4.99. In conclusion, we have summarized, categorized and analyzed the scientific evidence regarding signs and symptoms in HS patients and their impairment in QoL. Their assessment should be thorough and included during routine evaluation of HS patients to motivate therapeutic modifications and increase patients’ health.

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Section: Resultsmentioning

confidence: 99%

“…Thirteen studies evaluated the impact of pain in the QoL of HS patients, including 4216 participants with a mean age of 35.62 years ( Table 2 ) [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis

Montero‐Vílchez

Díaz-Calvillo

Rodríguez-Pozo

et al. 2021

IJERPH

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“…The prevalence of a neuropathic pain component in almost one-third of HS patients in our study is in line with the results of a previous retrospective study, also using the PDQ tool. In the study of Huilaja et al the presence of a “likely” neuropathic pain status was reported in 31.5% of HS patients, especially in cases with psychiatric comorbidities, higher QoL impairment and with moderate-severe pain ratings [ 8 ]. In the same study, the use of pain-medication was trending lower in PDQ-negative patients, but there was no information on concomitant HS-specific treatment.…”

Section: Discussionmentioning

confidence: 99%

“…HS patients frequently report typical neuropathic pain-qualities, such as “shooting”, “itchy”, “blinding”, “stinging” and “burning” sensations, as well as chronic pruritus [ 7 ]. The prevalence of a neuropathic pain component in the HS patient population is poorly described but has been consistently reported in other chronic inflammatory skin conditions, such as psoriasis, psoriatic arthritis and atopic dermatitis [ 8 , 9 , 10 ]. Despite the central role of pain as a relevant outcome measure in clinical trials, therapeutic management of pain in HS patients is limited and current clinical practice guidelines (CPGs) do offer only generic advice on specific pain medications [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Neuropathic Pain and Related Characteristics in Hidradenitis Suppurativa: A Cross-Sectional Study

Garcovich

Muratori

Moltrasio

et al. 2020

JCM

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Background: Pain is a core symptom of hidradenitis suppurativa (HS) and is of complex, multifactorial origin. HS patients frequently report typical neuropathic pain qualities, but its prevalence has been poorly described. Methods: In this cross-sectional study, we examine the prevalence of neuropathic pain (NP) component and related pain-characteristics of a hospital-based cohort of patients with symptomatic HS. We administered the pain-DETECT tool (PDQ), a validated screening tool for NP, collecting clinical and patient-reported data on pain, pruritus and pain-management. We obtained 110 complete datasets from symptomatic HS patients (49.1% females; Hurley I (27.3%])–II (45.5%)–III (27.3%)). According to the PDQ tool, 30% of patients were classified with a high probability (>90%) of neuropathic pain (LNP). LNP status was significantly associated with increased pain severity, disease activity, pruritus intensity and use of pain medication. Regression analysis showed a significant impact of the PDQ score on patient-reported outcomes, including pain severity and the dimensions of activity and affective pain interference. HS patients may present a mixed chronic pain phenotype with a neuropathic component, thus requiring additional pain-assessments. A multi-modal approach to pain management, in combination with disease-specific treatment, should be implemented in future interventional studies.

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“…These results are compatible with the important role of inflammation 1 and obesity/metabolic syndrome in HS, 5 the postulated endocrine dysregulation 6 and the role of the microbiome in HS 7 as well as pain as the major symptom of the disease. 8 Moreover, the data presented enrich our list of interesting compounds as repurposing candidates for HS. 3 However, our study also has limitations, as it investigated relatively small numbers of possibly pre-treated patients, which may have complicated data interpretation.…”

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confidence: 88%

An additional drug repurposing study for hidradenitis suppurativa/acne inversa

2020

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Patients with hidradenitis suppurativa may suffer from neuropathic pain: A Finnish multicenter study

Cited by 17 publications

References 6 publications

The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis

The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis

Prevalence of Neuropathic Pain and Related Characteristics in Hidradenitis Suppurativa: A Cross-Sectional Study

An additional drug repurposing study for hidradenitis suppurativa/acne inversa

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