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Pain, Psychological Comorbidities, Disability, and Impaired Qualify of Life in Hidradenitis Suppurativa

  • Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
  • Published:
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A Correction to this article was published on 18 November 2017

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Abstract

Purpose of Review

Hidradenitis suppurativa (HS) is a chronic, painful dermatologic disease characterized by recurrent inflammatory nodules and abscesses of intertriginous areas such as the axilla and groin. People with HS suffer from greater pain and associated psychological comorbidities, including depression, anxiety, disability, and impairments in quality of life (QoL), compared to those with other dermatologic conditions. Our review focuses on the occurrence of pain and these relationships.

Recent Findings

The existing literature indicates that acute and chronic pain, depression, anxiety, and disability all contribute to poor quality of life in individuals with HS. Despite the central role of pain and distress in the presentation of HS, few studies have empirically evaluated the impact of pain and gaps remain in the existing psychosocial literature. There are no formal guidelines for treating HS-specific pain or psychological comorbidities.

Summary

The results of this review show a clear and pressing need to develop treatment recommendations and effective interventions for addressing acute and chronic pain, psychological comorbidities, disability, and impaired quality of life among people with HS. This review outlines a multidisciplinary approach to treating and managing pain and psychological comorbidities.

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Change history

  • 18 November 2017

    The original version of this article contains an error in the spelling of the title. The title should read: Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Garg A, Lavian J, Lin G, Strunk A, Alloo A. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;153(8):760–64. https://doi.org/10.1001/jamadermatol.2017.0201.

  2. Saunte DM, Boer J, Stratigos A, Szepietowski JC, Hamzavi I, Kim KH, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015;173(6):1546–9. https://doi.org/10.1111/bjd.14038.

    Article  CAS  PubMed  Google Scholar 

  3. Smith HS, Chao JD, Teitelbaum J. Painful hidradenitis suppurativa. Clin J Pain. 2010;26(5):435–44. https://doi.org/10.1097/AJP.0b013e3181ceb80c.

    Article  PubMed  Google Scholar 

  4. Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhasz I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619–44. https://doi.org/10.1111/jdv.12966.

    Article  CAS  PubMed  Google Scholar 

  5. Jemec GB, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol. 2015;73(5 Suppl 1):S4–7. https://doi.org/10.1016/j.jaad.2015.07.052.

    Article  PubMed  Google Scholar 

  6. Jemec GB, Heidenheim M, Nielsen NH. The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol. 1996;35(2 Pt 1):191–4.

    Article  CAS  PubMed  Google Scholar 

  7. Jemec GB. The symptomatology of hidradenitis suppurativa in women. Br J Dermatol. 1988;119(3):345–50.

    Article  CAS  PubMed  Google Scholar 

  8. Vinding GR, Miller IM, Zarchi K, Ibler KS, Ellervik C, Jemec GB. The prevalence of inverse recurrent suppuration: a population-based study of possible hidradenitis suppurativa. Br J Dermatol. 2014;170(4):884–9. https://doi.org/10.1111/bjd.12787.

    Article  CAS  PubMed  Google Scholar 

  9. Reeder VJ, Mahan MG, Hamzavi IH. Ethnicity and hidradenitis suppurativa. J Invest Dermatol. 2014;134(11):2842–3. https://doi.org/10.1038/jid.2014.220.

    Article  CAS  PubMed  Google Scholar 

  10. Miller IM, McAndrew RJ, Hamzavi I. Prevalence, risk factors, and comorbidities of hidradenitis suppurativa. Dermatol Clin. 2016;34(1):7–16. https://doi.org/10.1016/j.det.2015.08.002.

    Article  CAS  PubMed  Google Scholar 

  11. •• Gill L, Williams M, Hamzavi I. Update on hidradenitis suppurativa: connecting the tracts. F1000Prime Rep. 2014;6:112. 10.12703/P6-112. This paper emphasizes the importance of assessing psychiatric comorbidities in patients with HS.

    PubMed  PubMed Central  Google Scholar 

  12. Zouboulis CC, Tsatsou, F. Chapter 85: Disorders of the apocrine sweat gland. Fitzpatrick’s Dermatology in General Medicine 8th Edition. McGraw-Hill Medical; 2012.

  13. van der Zee HH, Jemec GB. New insights into the diagnosis of hidradenitis suppurativa: clinical presentations and phenotypes. J Am Acad Dermatol. 2015;73(5 Suppl 1):S23–6. https://doi.org/10.1016/j.jaad.2015.07.047.

    PubMed  Google Scholar 

  14. • Onderdijk AJ, van der Zee HH, Esmann S, Lophaven S, Dufour DN, Jemec GB, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol0. 2013;27(4):473–8. https://doi.org/10.1111/j.1468-3083.2012.04468.x. This paper describes a cross-sectional study that showed depression to be higher in patients with HS than other dermatological conditions.

    Article  CAS  Google Scholar 

  15. •• Ring HC, Theut Riis P, Miller IM, Saunte DM, Jemec GB. Self-reported pain management in hidradenitis suppurativa. Br J Dermatol. 2016;174(4):909–11. https://doi.org/10.1111/bjd.14266. This paper provides a patient perspective on HS-related pain.

    Article  CAS  PubMed  Google Scholar 

  16. Balieva F, Kupfer J, Lien L, Gieler U, Finlay AY, Tomas-Aragones L, et al. The burden of common skin diseases assessed with the EQ5D: a European multicentre study in 13 countries. Br J Dermatol. 2016; https://doi.org/10.1111/bjd.15280.

  17. • Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158–64. https://doi.org/10.1056/NEJMcp1014163. This paper is the most recent HS review paper published in a high impact journal and provides an overview of the disease and available treatments.

    Article  CAS  PubMed  Google Scholar 

  18. •• Horvath B, Janse IC, Sibbald GR. Pain management in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(5 Suppl 1):S47–51. https://doi.org/10.1016/j.jaad.2015.07.046. This paper is one of the only published articles with guidelines and recommendations for pain management in HS.

    Article  PubMed  Google Scholar 

  19. • Enamandram M, Rathmell JP, Kimball AB. Chronic pain management in dermatology: a guide to assessment and nonopioid pharmacotherapy. J Am Acad Dermatol. 2015;73(4):563–73. https://doi.org/10.1016/j.jaad.2014.11.039. quiz 73-4. These papers are the most recent guidelines for addressing pain with opioid and non-opioid analgesics in dermatology.

    Article  PubMed  Google Scholar 

  20. Ring HC, Sorensen H, Miller IM, List EK, Saunte DM, Jemec GB. Pain in Hidradenitis suppurativa: a pilot study. Acta Derm Venereol. 2016;96(4):554–6. https://doi.org/10.2340/00015555-2308.

    Article  PubMed  Google Scholar 

  21. • Enamandram M, Rathmell JP, Kimball AB. Chronic pain management in dermatology: pharmacotherapy and therapeutic monitoring with opioid analgesia. J Am Acad Dermatol. 2015;73(4):575–82. https://doi.org/10.1016/j.jaad.2014.11.038. quiz 83-4. These papers are the most recent guidelines for addressing pain with opioid and non-opioid analgesics in dermatology.

    Article  PubMed  Google Scholar 

  22. Kimball AB, Kerdel F, Adams D, Mrowietz U, Gelfand JM, Gniadecki R, et al. Adalimumab for the treatment of moderate to severe hidradenitis suppurativa: a parallel randomized trial. Ann Intern Med. 2012;157(12):846–55. https://doi.org/10.7326/0003-4819-157-12-201212180-00004.

    Article  PubMed  Google Scholar 

  23. Grant A, Gonzalez T, Montgomery MO, Cardenas V, Kerdel FA. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial. J Am Acad Dermatol. 2010;62(2):205–17. https://doi.org/10.1016/j.jaad.2009.06.050.

    Article  CAS  PubMed  Google Scholar 

  24. Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375(5):422–34. https://doi.org/10.1056/NEJMoa1504370.

    Article  CAS  PubMed  Google Scholar 

  25. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–45. https://doi.org/10.1001/archinte.163.20.2433.

    Article  PubMed  Google Scholar 

  26. McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain. 2003;106(1–2):127–33.

    Article  PubMed  Google Scholar 

  27. Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County. Minnesota J Invest Dermatol. 2013;133(1):97–103. https://doi.org/10.1038/jid.2012.255.

    Article  CAS  PubMed  Google Scholar 

  28. • Kurek A, Johanne Peters EM, Sabat R, Sterry W, Schneider-Burrus S. Depression is a frequent co-morbidity in patients with acne inversa. J Dtsch Dermatol Ges. 2013;11(8):743–9,-20. https://doi.org/10.1111/ddg.12067. This paper discusses the potential causes of high comorbidity between depression and HS.

    PubMed  Google Scholar 

  29. •• Dufour DN, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgrad Med J. 2014;90(1062):216–21. https://doi.org/10.1136/postgradmedj-2013-131994. quiz 20. This is one of the few papers that address the impact of HS on work and social interactions.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Vinding GR, Knudsen KM, Ellervik C, Olesen AB, Jemec GB. Self-reported skin morbidities and health-related quality of life: a population-based nested case-control study. Dermatology. 2014;228(3):261–8. https://doi.org/10.1159/000358009.

    Article  CAS  PubMed  Google Scholar 

  31. Matusiak L, Bieniek A, Szepietowski JC. Hidradenitis suppurativa markedly decreases quality of life and professional activity. J Am Acad Dermatol. 2010;62(4):706–8, 8 e1. https://doi.org/10.1016/j.jaad.2009.09.021.

    Article  PubMed  Google Scholar 

  32. • Esmann S, Jemec GB. Psychosocial impact of hidradenitis suppurativa: a qualitative study. Acta Derm Venereol. 2011;91(3):328–32. https://doi.org/10.2340/00015555-1082. This paper provides detailed patient experiences with pain and emotional reactions related to HS.

    Article  PubMed  Google Scholar 

  33. Cheatle MD, Wasser T, Foster C, Olugbodi A, Bryan J. Prevalence of suicidal ideation in patients with chronic non-cancer pain referred to a behaviorally based pain program. Pain Physician. 2014;17(3):E359–67.

    PubMed  Google Scholar 

  34. Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GB, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984–91. https://doi.org/10.1038/jid.2014.530.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139(5):846–50.

    Article  CAS  PubMed  Google Scholar 

  36. Gupta MA, Schork NJ, Gupta AK, Kirkby S, Ellis CN. Suicidal ideation in psoriasis. Int J Dermatol. 1993;32(3):188–90.

    Article  CAS  PubMed  Google Scholar 

  37. Garg A, Pomerantz, M., Midura, M., Papgermanos, V., Strunk, A., Merson, J., Alloo, A. Completed suicide in patients with hidradenitis suppurativa: a population analysis in the United States. Society for Investigative Dermatology 76th Annual Meeting; April 26–29, 2017; Portland, Oregon. J Investig Dermatol. 137 (5S1); May, 2017, Abstract #222.

  38. Shavit E, Dreiher J, Freud T, Halevy S, Vinker S, Cohen AD. Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2015;29(2):371–6. https://doi.org/10.1111/jdv.12567.

    Article  CAS  PubMed  Google Scholar 

  39. •• Kouris A, Platsidaki E, Christodoulou C, Efstathiou V, Dessinioti C, Tzanetakou V, et al. Quality of life and psychosocial implications in patients with hidradenitis suppurativa. Dermatology. 2017; https://doi.org/10.1159/000453355. This is one of the few papers that address comorbid anxiety in the HS population.

  40. • Wolkenstein P, Loundou A, Barrau K, Auquier P, Revuz J. Quality of life impairment in hidradenitis suppurativa: a study of 61 cases. J Am Acad Dermatol. 2007;56(4):621–3. https://doi.org/10.1016/j.jaad.2006.08.061. This paper emphasizes the profound impact of HS on quality of life compared to other dermatologic conditions.

    Article  PubMed  Google Scholar 

  41. Deckers IE, Kimball AB. The handicap of hidradenitis suppurativa. Dermatol Clin. 2016;34(1):17–22. https://doi.org/10.1016/j.det.2015.07.003.

    Article  CAS  PubMed  Google Scholar 

  42. Janse IC, Deckers IE, van der Maten AD, Evers AW, Boer J, van der Zee HH et al. Sexual health and quality of life are impaired in hidradenitis suppurativa: a multicentre cross-sectional study. Br J Dermatol. 2016;176(4);1042–47. https://doi.org/10.1111/bjd.14975.

  43. Kurek A, Peters EM, Chanwangpong A, Sabat R, Sterry W, Schneider-Burrus S. Profound disturbances of sexual health in patients with acne inversa. J Am Acad Dermatol. 2012;67(3):422–8, 8 e1. https://doi.org/10.1016/j.jaad.2011.10.024.

    Article  PubMed  Google Scholar 

  44. von der Werth JM, Jemec GB. Morbidity in patients with hidradenitis suppurativa. Br J Dermatol. 2001;144(4):809–13.

    Article  PubMed  Google Scholar 

  45. Gerard AJ, Feldman SR, Strowd L. Quality of life of patients with pyoderma gangrenosum and hidradenitis suppurativa. J Cutan Med Surg. 2015;19(4):391–6. https://doi.org/10.1177/1203475415575013.

    Article  PubMed  Google Scholar 

  46. •• Sisic M, Kirby JS, Boyal S, Plant L, McLellan C, Tan J. Development of a quality-of-life measure for hidradenitis suppurativa. J Cutan Med Surg. 2017;21(2):152–5. https://doi.org/10.1177/1203475416677721. This paper addresses the development of an HS-specific quality of life measure.

    Article  PubMed  Google Scholar 

  47. Tait RC, Chibnall JT, Krause S. The pain disability index: psychometric properties. Pain. 1990;40(2):171–82.

    Article  CAS  PubMed  Google Scholar 

  48. Kaaz K, Matusiak, L., Szepietowski, J.C. Sleep disturbances among hidradenitis suppurativa patients. European Hidradenitis Suppurativa Foundation 6th Conference; February 8–10, 2017; Copenhagen, Denmark: Experimental Dermatology; 2017; 26 (Supple. 1); 3–38; February, 2017 Abstract #O06-3.

  49. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1–9. https://doi.org/10.1037/0278-6133.26.1.1.

    Article  PubMed  Google Scholar 

  50. Amtmann D, Cook KF, Jensen MP, Chen WH, Choi S, Revicki D, et al. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150(1):173–82. https://doi.org/10.1016/j.pain.2010.04.025.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Fitzpatrick SL, Stevens VJ. Adult obesity management in primary care, 2008–2013. Prev Med. 2017;99:128–33. https://doi.org/10.1016/j.ypmed.2017.02.020.

    Article  PubMed  Google Scholar 

  52. Barth J, Critchley J, Bengel J. Efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease: a systematic review and meta-analysis. Ann Behav Med. 2006;32(1):10–20. https://doi.org/10.1207/s15324796abm3201_2.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hidradenitis Suppurativa Treatment Center, Division of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Zarine S. Patel, Lauren K. Hoffman, Steven R. Cohen & Michelle A. Lowes

  2. Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, USA

    Zarine S. Patel, Amy S. Grinberg & Elizabeth K. Seng

  3. Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Lauren K. Hoffman

  4. Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA

    Dawn C. Buse

  5. University of Miami, Miller School of Medicine, Miami, FL, USA

    Ladan Afifi

  6. Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA

    Elizabeth K. Seng

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  1. Zarine S. Patel
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  2. Lauren K. Hoffman
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Corresponding author

Correspondence to Elizabeth K. Seng.

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Conflict of Interest

Zarine S. Patel, Lauren K. Hoffman, Amy S. Grinberg, and Ladan Afifi have nothing to disclose.

Dawn Buse is a member of an Advisory Board for Eli Lilly, Amgen Pharmaceuticals, and Biohaven Pharmaceuticals and has received research support from Allergan Pharmaceuticals, Promeius Pharmaceuticals, and Avanir Pharmaceuticals.

Steven Cohen has received grant money from AbbVie Pharmaceuticals during this study.

Michelle Lowes has received a modest honorarium and/or travel expenses for speaking at conferences or educational settings, including Symposium on Advanced Wound Care (SAWC), Hidradenitis Suppurativa, Las Vegas, Nevada, Oct 7, 2016; Organizing Committee, Inaugural Symposium on Hidradenitis Suppurativa Advances (SHSA), Toronto, Canada, Oct 22–23, 2017; Video roundtable on Hidradenitis Suppurativa, hosted by Cutis and Derm News, New York, Feb 3, 2017.

Elizabeth Seng reports personal fees from GlaxoSmithKline and personal fees from Haymarket Media outside of this work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

A correction to this article is available online at https://doi.org/10.1007/s11916-017-0653-5.

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Patel, Z.S., Hoffman, L.K., Buse, D.C. et al. Pain, Psychological Comorbidities, Disability, and Impaired Qualify of Life in Hidradenitis Suppurativa. Curr Pain Headache Rep 21, 49 (2017). https://doi.org/10.1007/s11916-017-0647-3

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