Hidradenitis suppurativa has a devastating impact on mental health

By Mardi Chapman

27 Aug 2020

A/Prof Saxon Smith

Dermatology patients with hidradenitis suppurativa (HS) are likely to have significant issues with drug and alcohol disorders, suicide and other psychiatric comorbidities, a study shows.

A systematic review and meta-analysis of the evidence identified 12 large case-control studies reporting on associations between HS and substance use, suicide or psychiatric conditions.

The study, published in Annals of Translational Medicine, found suicide was twice as likely in people with HS than in controls (OR 2.08).

Similarly, substance-related disorders were more than twice as common in people with HS (OR 2.84) and alcohol abuse was almost twice as likely (OR 1.94).

People with HS also had a significantly higher odds of having schizophrenia (OR 1.69), bipolar disorders (OR 1.96), depression (OR 1.75), anxiety (OR 1.71) and personality disorders (OR 1.50) than controls.

Overall, the odds ratio of an association between HS and any psychiatric disorder was a highly significant 1.75 (p <0.00001).

“These results highlight the large mental health and drug abuse burden on patients with HS and the importance of a multidisciplinary approach to care for patients with HS,” the study authors said.

Led by senior investigator Associate Professor Saxon Smith from Sydney’s Royal North Shore Hospital, the study said HS was a “debilitating, painful and isolating disease which substantially lowers patients’ quality of life.”

“Therefore, for dermatologists treating patients with HS, screening for these comorbidities, psychiatric referral and adequately managing pain will improve the overall wellbeing of patients.”

The study noted patients typically reported pain was their most difficult symptom to manage and that it may have a greater influence on substance-related disorders than many other factors.

“This highlights the importance of adequately managing pain from HS lesions, as well as screening for the use of alcohol, opioids and/or cannabis, particularly in those experiencing severe pain from HS.”

It also said the increased risk of suicide reinforced the “devastating psychological impact of HS on patient’s lives.”

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