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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.[1] 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.[1]

 

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.[1] 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.[2] 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.[3] 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.[10]

 

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.[11] 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.[12]

 

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,[11] 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.[12] 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.

* 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. Hidradenitis suppurativa | DynaMed Plus. 2017; Link to research.
  2. Kurosumi K, Shibasaki S, Ito T. Cytology of the secretion in mammalian sweat glands. Int Rev Cytol.1984;87:253-329; PMID: 6370891 Link to research.
  3. 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.
  4. Beier K, Ginez I, Schaller H. Localization of steroid hormone receptors in the apocrine sweat glands of the human axilla. Histochemistry and Cell Biology.2005;123(1):61-65; PMID: Link to research.
  5. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol.2009;60(4):539-561; quiz 562-533; PMID: 19293006 Link to research.
  6. Woodruff CM, Charlie AM, Leslie KS. Hidradenitis Suppurativa: A Guide for the Practicing Physician. Mayo Clin Proc.2015;90(12):1679-1693; PMID: 26653298 Link to research.
  7. Hidradenitis suppurativa | American Academy of Dermatology. 2017; Link to research. Accessed August 27, 2017.
  8. Deckers IE, van der Zee HH, Prens EP. Epidemiology of Hidradenitis Suppurativa: Prevalence, Pathogenesis, and Factors Associated with the Development of HS. Current Dermatology Reports.2014;3(1):54-60; PMID: 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. 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.
  11. 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.
  12. 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.
MakeupMicrobiomeTCMDiagnosis and DetailsReproductive HealthDevicesSkin MicrobiomePsoriasisFoodVitamins and SupplementsNaturopathy BasicsHerbal ExtractsAyurvedaSun CareClimateMineralsWestern BasicsStress Effects on SkinIngredientsHairAnti-AgingRosaceaPerspectivesPregnancyGut MicrobiomeVitamin DDietProduct InfoNutritionHealthy AgingWesternProbiotics and PrebioticsExerciseHolistic TherapiesFitnessMental HealthOTC ProductsInfectionsAcneBeautyNailsYogaOmega-3 Rich FoodsEnvironmentMindfulnessAyurveda BasicsSexual HealthSunscreenAlopeciaBeauty SmartsAtopic DermatitisMassageIngredient ScienceMedicationsProceduresStressNatural ProductsNaturopathyCosmetics and ProceduresAntioxidantsHerbs and BotanicalsNatural IngredientsStress ReductionSun SmartsAcupunctureSkin FoodsAntioxidant FoodsBiopsyWater QualityVitaminsVirusesFinding Personal HarmonyIntegrative ApproachMushrooms and FungiSkin Barrier ProtectionEye CareAestheticsBiological TreatmentBody CareChemistryClaysCosmeticsEpigeneticsSkin DiscolorationSkin BasicsAntioxidants for SkinChemical Effects on the SkinVaginal HealthAsian Skin CareBody OilCancerVitamin AThe Microbiome in EczemaSkin Type ProfileSkin Care for MenSkin CancerSuperfoodsSkin in PregnancyFood SensitivityGlycemic IndexHair Loss CausesSexually Transmitted DiseaseSkin Affects PsychologyAlternatives to AntibioticsAutoimmuneAyurvedic Medical ApproachesBasal Cell CarcinomaBiologicsBleach BathsBody ContouringVitiligoVegan Skin CareQuality of LifeHarmful Effects of UV LightAyurvedic DoshasAyurvedic PractitionersBlue Light EffectsBotulinum ToxinWrinklesComplementary and Alternative MedicineUV LightUltraviolet Light Based TreatmentEffects of AgingEssential OilsFiber IntakeSkin BlistersDiagnosisHair HealthActive LifestyleApps and ToolsVitamin CSquamous Cell Skin CancerSkin DetoxSkin Aging and Fine LinesTeaFoods for Skin CareEffects of DairySkingredientsHair and NailsAccess To CareAlcoholAvocadoBaby Skin CareBacteria and ParasitesBathingEnvironmental Effects on SkinFacial MasksSkin of ColorSkin Gut ConnectionSkin DNA ChangesLifestyle Tips for AcneCleansersAutoimmune Skin DiseaseBalneotherapyBathBeneficial Effects of GroomingBiological AgentsClothingCuppingSystemic Medications for PsoraisisNatural Oils for the SkinHealthy Sun HabitsSkin CareHidradenitis SuppurativaBiological MedicationsBotoxChakras and the SkinSweating More Than UsualFastingUsing SunscreenPhytochemicalsAllergiesBotulinum Toxin for CosmeticsAntibiotic UseBathing with Dry SkinBlistering DiseaseCastorYoga For Skin HealthYellow NailsTraditional Chinese Medicine ApproachesThe Benefits of PetsSportsSkin Signs of Internal DiseaseSensitive SkinExfoliatorsNon-Surgical Cosmetic ProceduresActinic KeratosesAgingBehavioral HealthChemotherapyChinese Medicine BasicsWound HealingCircadian RhythmUsing Steroids SafelyThe Power of SleepTanningSpironolactoneSkin LighteningShavingWellnessSun ProtectionKeratosis PilarisSkin IrritationFemale Sexual HealthAntibiotic Use for More Than InfectionsBacterial BiofilmsBarber ShopsBodyWeight LossWartsDry ScalpFat ReductionMelanoma Skin CancerOxidative StressSugar Effects on SkinBleachBotulinum Toxin for Medical PurposesCalciumWorld Influences on Skin CareCosmetic ProceduresThe Skin We're InSunburnMind Skin ConnectionHealthy FoodsAlternative Approaches for EczemaHealthy HygieneMoisturizersChoosing A SunscreenNatural Skin CareCosmetic CornerAyurvedic ApproachesBeta GlucanBiomedicineCelluliteChemicals Used in Skin ProductsDry SkinTechnology for Your SkinExercise and Physical ActivityEyelash CareSkin TipsSafety of IngredientsDiet Effects on SkinAntiperspirantAromatherapyBacteria, Fungi and ParasitesDrug ReactionsSkin BiopsyScar TreatmentsEczemaSupplementsMale Sexual HealthBasal Cell Skin CancerBeneficial Effects of OatsWoundFacialsSkin ProcedureResearch SpotlightProduct LabelsHair GrowthOily SkinHome DevicesNail SalonsChinese MedicineInfo on Product LabelsIntegrative MedicineNutraceuticalsNaturopathic MedicineGreen TeaOmega-3OpinionNaturopathic ApproachesGenetics of SkinAyurvedic MedicineNicotinamideNail BeautyHealthy BathingRetinoidsSafe SexRadiation TherapyLights and LasersSexualityPower of Social MediaIsotretinoin AccutaneIntense Pulsed LightHyperhidrosisHoney Health for SkinNiacinamideMedication TipsLifestylepH of the SkinPollution Effects on SkinMelasmaMediterranean DietHerbal CareLaser TreatmentsMeditationHair ReductionInsects and ParasitesNanoparticlesItchingNail CareMedications That Suppress the Immune SystemHow to Read Product LabelsCosmeceuticalsInjectablesInfections of the SkinSkinPaleo DietFit Living is Healthy SkinHealthy Living is Healthy SkinMind and BodyLifestyle Tips for EczemaHomeopathyHair CareNail HealthHormone Effects on the SkinChemicalsMore Than Skin DeepGrainsModern MedicineDermatologistHow Stuff WorksBack to BasicsHair OilsSoap AlternativesSkin Physics SpotlightHair SupplementsFoods for Hair HealthHair LossPlant Based DietMedicineIntegrative Approach to SkinCOVID-19Eye and Oral CareFacial CareEye MicrobiomeNonmelanoma Skin CancerViruses and BacteriaMedicine BasicsHealthy DrinksGut HealthDry ShampoosStress and MindfulnessEstheticians