Mental Health in Hidradenitis Suppurativa
When many of us think of acne, we think of the classic red bumps and pustules on the face, chest, and back, usually emerging in early adolescence. Yet for those suffering and living with hidradenitis suppurativa, their “acne” is often hidden on concealed areas of skin, such as in the armpits, groin folds, and between the buttocks. While usually covered by natural skin creases and everyday clothing, these lesions can become visible in instances such as swimming or working out, when more skin is displayed. During flares, these red nodules can become excruciatingly painful, burrow deeper in the skin, and drain foul-smelling fluid. For those who from hidradenitis suppurativa, something important to remember is that the disease is not contagious and not due to poor hygiene.
What Is Hidradenitis Suppurativa
Living with hidradenitis suppurativa is characterized by chronic inflammation of apocrine sweat glands and typically occurs around blocked hair follicles; it can be thought of as a severe variant of acne. In the skin, sweat glands are divided into two main types: eccrine and apocrine. Eccrine sweat glands are located throughout almost the entire body surface and help maintain body temperature. Apocrine sweat glands are located in areas like the armpits and around the anus. These sweat glands begin functioning during puberty and activate during times of stress and sexual excitement. These pheromone-producing glands are likely stimulated by the sex hormones that are synthesized in the onset of puberty.[4,5]
Unfortunately, the exact cause of hidradenitis suppurativa is not well understood, but medical providers know that it is more common in women, smokers, and overweight individuals.[6,7] It is estimated that this disease affects 1% of the United States population.[8,9] One proposed explanation is that when a hair follicle becomes plugged with bacteria and other skin debris, the body’s immune system overreacts, leading to the typical boil formation, pain, and drainage.
Mental Health Issues in Those Living with Hidradenitis Suppurativa
Both healthcare providers and those who suffer from hidradenitis suppurativa should understand that the disease’s chronic nature can affect not only physical health but also mental health. In focus group interviews of hidradenitis suppurativa patients, many expressed that their hidradenitis suppurativa often limited their daily activities and made them apprehensive about making future plans due to concerns about potential disease flares. They noted that flaring could last for up to two weeks, during which they felt helpless. In a Finnish study, one-quarter of patients suffering from hidradenitis suppurativa also had a psychiatric illness, such as depression. The study suggested that patients living with hidradenitis suppurativa suffered more from a mental health standpoint than those with other common skin conditions.
Hidradenitis Suppurativa Affects Confidence
Many avoid public spaces, becoming isolated within the confines of their homes. One patient reported that after her initial diagnosis at age 14, she feared to date and attempted to commit suicide several times due to low self-esteem. Other individuals felt they had a constant bad odor around them, prompting them to bathe and change clothes multiple times a day. Hidradenitis suppurativa can be socially catastrophic for patients, as those who are afflicted may not even feel comfortable speaking about the disease with their own family. While this condition can promote isolation out of fear of embarrassment and/or stigmatization, discussing treatment plans with a healthcare provider can help improve hidradenitis suppurativa as well as mental health.
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- Braun-Falco O, Plewig GW, Helmut H. Burgdorf, Walter H. C. Diseases of the Apocrine Sweat Glands. Dermatology;10.1007/978-3-642-97931-6_29: Springer Berlin Heidelberg; 2000:1083-1086.
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- 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.
- Moran B, Sweeney CM, Hughes R, et al. Hidradenitis suppurativa is characterised by dysregulation of the Th17:Treg cell axis, which is corrected by anti-TNF therapy. J Invest Dermatol.2017;10.1016/j.jid.2017.05.033PMID: 28652108 Link to research.
- Jemec GB. Quality of life considerations and pain management in hidradenitis suppurativa. Semin Cutan Med Surg.2011;36(2):75-78; PMID: 28538748 Link to research.
- Huilaja L, Tiri H, Jokelainen J, et al. Patients with hidradenitis suppurativa have a high psychiatric disease burden: A Finnish nationwide registry study. J Invest Dermatol.2017;10.1016/j.jid.2017.06.020PMID: 28736236 Link to research.