Hidradenitis Suppurativa: More Than Just Boils in the Armpits...

Psychological effects of hidradenitis suppurativa

After a dreadfully cold winter season, you excitedly don on a tank top and shorts. However, as you slip on that tank top, you notice painful red bumps on your armpits. You pull at your skin to get a better look of it in the mirror before dejectedly slipping off the tank top, and changing to something that will cover those unsightly red bumps. Is this acne or folliculitis? Why does it keep coming back? What is wrong with me? 

 

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS) is a type of chronic inflammatory skin condition that causes painful red bumps and abscesses in areas where the skin rubs together—primarily the armpits, breasts, groin, and buttocks. Hidradenitis suppurativa is thought to initially be caused by the abnormal plugging of hair follicles. Friction from skin rubbing together in affected areas can lead to inflammation of the plugged hair follicle, and in some cases, abscess formation. Ruptured abscesses can lead to sinus tract development and scarring of the skin.

 

Who Is Affected by Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS) is seen more commonly in women than men and tends to affect women between the age of 18-44.[1] Risk factors for HS include a family history of HS, tobacco use and obesity. It is usually diagnosed clinically by a physician based on the physical appearance and location of the lesions. Another major clue in the diagnosis of HS is based on the tendency for the characteristic lesions to recur.[2]

 

Psychosocial Effects of Hidradenitis Suppurativa

Since HS tends to affect areas of the body that are more “private,” people suffering from HS often feel embarrassed about their condition. This can ultimately lead to difficulty engaging in intimate relationships and low self-esteem.[3,4] The pain, drainage, abnormal odor and scarring of the lesions, and the fact that it can be difficult to treat, all contribute to psychological distress in individuals affected by HS.[5] Although HS is not contagious, some people report fearing that others would think so.[6]

A study conducted in 2015 found that a greater proportion of patients with HS suffered from depression and anxiety when compared to healthy controls, even after controlling for age and gender.[7] Individuals with HS are also more likely to report a lower quality of life, which correlates with their disease severity.[5,8]

Table 1. Psychosocial Impact of Hidradenitis Suppurativa

 

Patients with HS

Patients without HS

P-value

Prevalence of Depression[7]

5.8%

3.5%

(p <0.001)

Prevalence of Anxiety[9]

3.8%

2.3%

(p <0.001)

Dermatology Life Quality Index (higher scores correspond to lower quality of life)[8]

8.35

4.34

(p <0.001)

*The information in this table is adapted from multiple studies referenced above.

Many people with HS also find it difficult to do things that they enjoy. The painful nodules are often aggravated by movements that cause the skin to rub together, making it difficult to exercise. Moreover, physical activity is essential to maintaining a healthy mind and body and can be beneficial for boosting low mood states in individuals affected by anxiety and depression.

Although HS is mostly seen and treated as a skin disease, it can have profound impacts on the individual’s mental well-being. Those suffering from HS should be aware of the psychosocial impacts of the disease and reach out for help from a healthcare professional if they find themselves experiencing negative changes in mood.

 

How Is Hidradenitis Suppurtiva Treated?

Topical disinfectants are often used to treat HS, however, there has not been much evidence demonstrating their effectiveness in the treatment of HS. Antibiotics and anti-inflammatory biologic agents are the primary medications used to treat moderate to severe HS. Mild cases of HS can also be treated with steroid injections, but chronic lesions that do not respond to medication, are often treated with surgery.[10]

 

Is There Anything A Person with HS Can Do?

Although HS may look like acne or folliculitis, it is treated very differently. Early treatment can potentially minimize the chances of progressing to a more severe stage. 

Here are some things that can be done to reduce the severity of the disease:

  1. Healthy weight: Obesity is a major risk factor in the development and worsening of HS. Losing weight can help reduce the severity of the disease, and reduce aggravation of the nodules from the rubbing of skin folds.[11]
  1. Smoking cessation: Like obesity, tobacco use is a well-known risk factor for HS. In fact, smoking cessation has been shown to improve disease flares.[9]
  1. Loose-fitting clothes: Loose clothing can minimize excess friction, which can aggravate the lumps and cause them to become more inflamed and rupture. More comfortable, looser fitting bras and belts may also alleviate discomfort.
  1. Healthy, balanced, dairy-free diet: Dairy products and foods with a high glycemic index are associated with flares of hidradenitis suppurativa.[12] Avoid eating processed foods and dairy. Consider eating an anti-inflammatory diet filled with fresh fruits and vegetables.

IDS Callout

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Cosmatos I, Matcho A, Weinstein R, et al. Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States. J Am Acad Dermatol.2013;69(5):819; PMID: 24124817 Link to research.
  2. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol.2017;10:105-115; PMID: 28458570 Link to research.
  3. Janse IC, Deckers IE, van der Maten AD, et al. Sexual health and quality of life are impaired in hidradenitis suppurativa: a multicentre cross-sectional study. Br J Dermatol.2017;176(4):1042-1047; PMID: 27534591 Link to research.
  4. Kouris A, Platsidaki E, Christodoulou C, et al. Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa. Dermatology.2016;232(6):687-691; PMID: 28052274 Link to research.
  5. Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol.2010;90(3):264-268; PMID: 20526543 Link to research.
  6. Esmann S, Jemec GB. Psychosocial impact of hidradenitis suppurativa: a qualitative study. Acta Derm Venereol.2011;91(3):328-332; PMID: 21394419 Link to research.
  7. Shavit E, Dreiher J, Freud T, et al. Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol.2015;29(2):371-376; PMID: 24909646 Link to research.
  8. Onderdijk AJ, van der Zee HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol.2013;27(4):473-478; PMID: 22339940 Link to research.
  9. Vazquez BG, Alikhan A, Weaver AL, et al. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol.2013;133(1):97-103; PMID: 22931916 Link to research.
  10. Saunte DML, Jemec GBE. Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA.2017;318(20):2019-2032; PMID: 29183082 Link to research.
  11. Kromann CB, Deckers IE, Esmann S, et al. Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol.2014;171(4):819-824; PMID: 24804604 Link to research.
  12. Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol.2015;73(5 Suppl 1):S52-54; PMID: 26470617 Link to research.