Patients with the skin condition, hidradenitis suppurativa (HS), face a significantly higher risk of developing depression and anxiety compared with the general population, with local and international research studies confirming it.
Australian HS expert Associate Professor Erin McMeniman who practices at Princess Alexandra Hospital and Central Brisbane Dermatology and is Principal Research Fellow at the Frazer Institute is involved with multi-disciplinary teams treating HS and cutaneous lymphoma.
She said the link between HS and anxiety and depression was well-established, but it was good to see the research quantifying it – particularly when it comes to disease severity.
“I absolutely agree with the importance of awareness of the diagnosis, and that GPs and emergency doctors and dermatologists are aware and diagnose it early so that person can get treatment.”
Hidradenitis suppurativa is a chronic skin condition involving the immune system, which causes painful lumps to form under the skin, often in areas where skin rubs together such as armpits and the groin. The lumps can rupture, leading to scarring and tunnels under the skin, significantly impacting a patient’s quality of life due to pain and potential social stigma.
The prevalence of HS is estimated to be about 1-2 per cent and is predominant among female patients. Disease onset is usually in late adolescence, but patients affected by the disease have an average diagnostic delay of approximately seven years, causing severe psychological stress and unmet needs.
In a Danish cohort study published in JAMA Dermatology, a particularly high risk of mental disorders has been identified among female patients and among patients with alcohol use disorders and a history of tobacco smoking. Several reasons for an increased risk of psychiatric disorders have been suggested, including impaired body image and sexual dysfunction.
“Even small areas, or even only having two or three painful draining nodules or tracks in the groin area, for example, can make an enormous impact on a young person’s sexual confidence and ability to engage in sexual relationships,” she said.
“I’ve had young women in their late 20s who’ve never been in a sexual relationship, because they’re terrified that someone will see their groin area.”
Professor McMeniman said awareness of HS and the treatments available had improved dramatically in recent years, but there was still a lot of shame and humiliation attached to the disease.
“When they have presented early for medical help, they often are embarrassed even to show their family and friends, which is a particularly sad for me; they don’t want to show their parents, they feel embarrassed about the look of it, as opposed to diseases like external psoriasis, where at least often they’ll show friends and family the areas of skin,” she told TMR.
“So it feels particularly isolating when people don’t even want their mother in the room because they think it’s disgusting, it smells. We try to do a lot of work in explaining it’s an immune disease. It’s not your fault. It’s nothing for you to be ashamed of. You have a severe immune inflammatory disease.”
Professor McMeniman said GPs were playing an important role in ensuring patients were being diagnosed earlier – which made a huge difference to outcomes.
“Especially in the last year, I’ve had a number of teenage patients referred to me within 12 months of symptoms. That’s awesome, I am so excited when that happens,” she said.
“Then we can discuss with them all the preventative lifestyle measures. We can say to them, don’t ever start smoking, which is much easier than trying to quit if you’ve been smoking for 10 years.
“They’ll come in with only two or three lesions, say age 14 or 15, and it’s a really great place to also not have all those shame mantras instilled in their psyche about their disease.
“You can really educate the family and the patient: you have an immune disease. Whereas we know the heartbreaking stories of people who are now in their 40s and 50s, who at that time in life were told: wash more, you’re infectious, it’s germs – which, of course, made them feel awful.”
Professor McMeniman said the tide was definitely turning in the right direction with the internet proving to be a positive influence with online support groups.
HS has been associated with numerous somatic comorbidities, including cardiovascular disease, inflammatory bowel disease (IBD), metabolic syndrome, polycystic ovarian syndrome and spondylarthritis.
The substantial comorbid burden within the HS population has been attributed to several factors, including a high prevalence of obesity, smoking, genetic and environmental factors, and aspects associated with systemic inflammation.
Quotes pulled from a Medical Republic article with the same title.