Hidradenitits suppurativa (HS) is a chronic, painful inflammatory skin disease characterized by recurrent inflammatory nodules and abscesses. People with HS have high rates of pain, psychiatric comorbidities, associated disability, and impaired quality of life. In 2015, a consensus document was written describing guidelines for the treatment of HS. The document noted the substantial psychosocial impact of the disease, including depression. Most HS lesions are found in intertriginous areas including the axilla (armpit), inframammary, and anogenital regions. A substantial delay in recognizing HS is the norm, averaging seven years from onset to diagnosis.
While generally considered a disease process of the hair follicle and apocrine gland, the specific pathogenic mechanisms underlying HS remain unknown.
Hurley staging (I–III) is commonly used to classify disease severity. Acute pain is not relieved until nodules and abscesses rupture. inflammation can lead to persistent drainage of a malodourous purulent effluent from chronic painful dermal nodules and sinuses, and significant, debilitating scarring.
Management of pain in dermatologic conditions is important. Guidelines for pain management in dermatology recommend the monitored use of nonopioid analgesics. The European guidelines for the treatment of HS include recommendations for nonsteroidal anti-inflammatory drugs. Both guidelines for HS management discuss the cautious use of opioids for severe dermatological pain. Due to the national opioid crisis and the concern of addiction, dependence, misuse and diversion, the use of opioids for pain management must be considered judiciously
Depression is a well-established and common comorbidity among people with chronic pain or painful health conditions.
Anxiety in HS has been attributed to the fear of disease flare-ups and revealing scars to others, malodourous discharge, and financial distress.
The main factors that impact quality of life (QoL) will differ for each patient, but commonly include limitation of daily activities. The reduced QoL in HS is attributable to many factors, including chronic pain, disfigurement, malodorous discharge, scarring, and impaired sexual health.
The painful symptoms of HS can cause significant disability, including interference with work, social and leisure activities, and sleep.
Pain is a central component to the experience of living with HS. The most famous guidelines for the treatment of HS emphasize the need to manage and alleviate pain. In many cases a coordinated, multidisciplinary approach to the management of chronic painful conditions is most effective. A multidisciplinary approach may include a range of treatments from various providers often including specialist physicians, pain management physicians, psychologists, psychiatrists, social workers, physical therapists, occupational therapists, and other healthcare professionals.
Authors Zarine S Patel and coll
Newspaper: Curr Pain Headache Rep. 2017 Nov 1;21(12):49