Top

Published in:

01-12-2017 | Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)

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

Authors: Zarine S. Patel, Lauren K. Hoffman, Dawn C. Buse, Amy S. Grinberg, Ladan Afifi, Steven R. Cohen, Michelle A. Lowes, Elizabeth K. Seng

Published in: Current Pain and Headache Reports | Issue 12/2017

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.

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.

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.CrossRefPubMed

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

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.PubMedPubMedCentral

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

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.CrossRef

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.CrossRefPubMed

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. CrossRefPubMed

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. CrossRefPubMed

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. CrossRefPubMed

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.CrossRefPubMed

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. CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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

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. CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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. CrossRefPubMed

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

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

36.

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

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.CrossRefPubMed

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. CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

44.

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

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.CrossRefPubMed

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. CrossRefPubMed

47.

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

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

Title: Pain, Psychological Comorbidities, Disability, and Impaired Qualify of Life in Hidradenitis Suppurativa
Authors: Zarine S. Patel
Lauren K. Hoffman
Dawn C. Buse
Amy S. Grinberg
Ladan Afifi
Steven R. Cohen
Michelle A. Lowes
Elizabeth K. Seng
Publication date: 01-12-2017
Publisher: Springer US
Published in: Current Pain and Headache Reports / Issue 12/2017
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-017-0647-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 12/2017

Correction to: Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa

Headache in Resource-Limited Settings

Neuroimaging of Cavernous Malformations

Similarities and Differences Between Migraine in Children and Adults: Presentation, Disability, and Response to Treatment

Correction to: Sphenopalatine Ganglion Block in the Management of Chronic Headaches

Nerve Blocks in Pediatric and Adolescent Headache Disorders