Pain and late onset of hidradenitis suppurativa may affect employment and education

Inactive occupational status and low educational level were associated with pain, late onset of disease and more affected areas in patients with hidradenitis suppurativa.

According to the results of a study published in Actas Dermo-Sifiliograficas.

As a chronic, inflammatory and relapsing skin disease, HS is a painful condition associated with physical and psychiatric symptoms. The economic impact of the disease has also been demonstrated, with previous research showing that HS patients have significantly lower income growth and lower annual income compared to the general population.

“Many patients experience embarrassment, shame and social isolation because of their HS. It is therefore not surprising that the HS can have a negative impact on the level of education and professional activity,” the authors of the study said. “Some studies have mentioned the negative impact of HS on daily activity, but none have assessed the negative impact of HS on patients’ careers.”

They conducted a cross-sectional analysis of patients with HS seen at a tertiary hospital in Badalona, ​​Spain, between September 2017 and September 2018, to assess whether disease-specific variables influenced occupational status and level of care. education.

The study cohort participated in the European HS Register, a standardized questionnaire designed by the European HS Foundation, with the following variables examined:

  • Occupational status: the “active” occupational group included employees or students and the “inactive” group included those who were unemployed, on sick leave (permanent or temporary) or with a disability
  • Level of studies: non-university studies (primary or high school and vocational high school) and university studies (divided into less than 4 years or 4 years and more)
  • Independent variables: sex, age, body mass index (BMI), marital status, comorbidities (depression, pilonidal sinus, metabolic diseases, severe acne, arthritis, polycystic ovary, psoriasis or inflammatory bowel disease), smoking history and consumption of alcohol
  • Disease-related variables: age at onset of HS, time to diagnosis, dermatological quality of life index (DLQI; 0-1 no effect, 21-30 extreme effect), number of areas affected by HS (1 , 2 or > 3), work absences due to HS, possible effect of HS on career, scale of HS concerns (EVA, 1-10), relapses of the previous year, painful days, pain level (VAS, 1-10), suppuration scale (VAS, 1-10), and impact on sleep by HS (VAS, 1-10) over the previous month

Ninety-eight patients with HS (median [IQR] age, 39.7 [30.1-47.2] years; median age of HS onset, 19 [15.0-27.7] years; median time to diagnosis of HS, 8 [3-17]years; 65.3% women) were included in the study. Overall, 70.1% were overweight or obese, 79.4% had at least one comorbidity, and 23.7%, 21.5%, and 9.7% had moderate, severe, and extreme disease severity. HS according to the DLQI, respectively.

In addition, 23.1% and 76.8% of patients were respectively included in the university and non-university studies group and 63.3% were employed or students.

Compared to patients in the university studies group, those in the non-university group more frequently report 3 areas affected (22.5% vs 4.8%; P = 0.049), a higher mean (SD) number of painful days (8.5 [8.8] against 4.6 [4.8]; P = 0.048) and a higher score on the VAS scale (6.7 [2.8] vs. 5.0 [3.3]; P = 0.031).

Patients in the inactive group showed a significant increase in the average number of painful days (11.2 [10.4] against 5.7 [6.2]; P = 0.004), higher incidence of depression (61.3% versus 27.4%; P = 0.002) and a higher mean BMI (32.3 [9.1] against 28.4 [6.4]; P = 0.016) compared to the active group. Late onset of disease was found to be significantly associated with being in the inactive vs. active group (26.7% versus 6.5%; P = 0.026).

No significant differences between HS severity scales and educational level or occupational status were found.

The researchers concluded that physicians should take into account the significant relationship shown for poor pain control with lower education and inactive occupational status as it may be a modifiable disease variable. Limitations of the analysis included its cross-sectional, single-center study design.

Reference

Barboza-Guadagnini L, Podlipnik S, Fuertes I, Morgado-Carrasco D, Bassas-Vila J. Pain and late onset of hidradenitis suppurativa can negatively influence occupational status and educational level. A cross-sectional study. Actas Dermosifiliogr (English edition). Published online August 27, 2022. doi:10.1016/j.ad.2022.08.016

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