The Quality of Life impairment in Hidradenitis Suppurativa

Abstract

Background. Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease of terminal hair follicles with a profound impact on the patient’s daily life, probably one of the worst that has been analysed and evaluated in dermatology. Aim. The aim of this study was to evaluate the QoL impairment in HS and identify the factors that influence it. Methods. The study was conducted with a group of forty-two patients affected by HS, aged 10–62 years, referred to the HS consultation service of Dermatology Clinic of Tor Vergata. All patients filled out the Dermatology Life Quality Index (DLQI questionnaire). The DLQI’ questions are categorized into six heading items: symptoms and feelings, daily activities, leisure, personal relationships, work and school, and treatment. The severity of the HS disease was evaluated with the Hurley staging classification, the modified Sartorius score and the Acne Inversa Severity Index (AISI score). A visual analog scale was used for pain (PAIN VAS). Patients were divided into three groups according to AISI index score: mild (4 male, 8 female), moderate (2 male, 9 female) and severe patients (6 male, 13 female). Results. Our findings are in agreement with existing literature who claims that patients with HS have a significant impairment in QoL, expressed by high DLQI score (12,6 ± 8). The most compromised elements were clinical symptoms (1,60), feelings (1,64) and daily activities (1,71). The clinical stage of disease is the most important factor related to the DLQI. The significant positive correlation between the AISI scores and DLQI scores (Pearson's r = 0,53) confirms disease severity as a predictor of worsening QoL. Pain, discomfort and embarrassment are also involved. Presence of higher PAIN VAS score was associated with an increase in DLQI (Pearson's r = 0,6). QoL was affected by age: between 26 and 49 years, an increase of the DLQI values is observed; moreover, in this group of patients, HS is a limitation in study and work activities much more than in the other categories. In patients with severe forms, the choice of clothes to wear is an important cause of discomfort. This study does not reveal a correlation between disease severity and impact on sex life. Conclusion. HS is a profoundly debilitating disease which affects patient’ lives physically, emotionally and psychologically. The average recorded of the DLQI score is higher than those found in other chronic dermatologic conditions traditionally regarded as causing significant disability. For this reason, the need to measure the quality of life of HS patients becomes particularly significant, and therefore it could be helpful design a new evaluation method or score able to specifically monitor the HS impact on QoL and evidence clearly and enclosing yet overlooked aspects