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Heightened risk for psychiatric comorbidities in hidradenitis suppurativa patients

Presented by
Dr Kevin Phan, Liverpool Hospital, Australia
EADV 2020
A substantially increased risk for several psychiatric disorders as well as for substance and alcohol abuse was detected in patients with hidradenitis suppurativa (HS) in an Australian meta-analysis. The chronic inflammatory skin disease HS is known to reduce quality of life and has also been linked to factors such as smoking and comorbidities like obesity and metabolic syndrome [1-3].

Since previous studies have shown that chronic inflammatory skin diseases could be connected to psychiatric disorders, Dr Kevin Phan (Liverpool Hospital, Australia) and colleagues were interested in a possible association of HS with psychiatric comorbidities like depression, schizophrenia, or suicidal tendency [4-6]. They also looked at alcohol and substance abuse in this population. The researchers performed a meta-analysis of studies identified by an electronic database search and direct review of articles together with data about cases and controls [4].

Regarding psychiatric diagnoses, the study found significantly elevated risks for HS patient to suffer from schizophrenia (OR 1.66; 95% CI 1.53-1.79; P<0.00001), anxiety (OR 1.71; 95% CI 1.51-1.92; P<0.00001), bipolar disorders (OR 1.96; 95% CI 1.65-2.33; P<0.00001), depression (OR 1.75; 95% CI 1.44-2.13; P<0.00001), and personality disorders (OR 1.50; 95% CI 1.18-1.92; P=0.001). The likelihood of suicide was around 2 times higher (OR 2.08; 95% CI 1.27-3.42; P=0.004) and in about the same order of magnitude as alcohol abuse (OR 1.94; 95% CI 1.43-2.64; P<0.0001). The odds for substance-related disorders were almost 3 times higher (OR 2.84; 95% CI 2.33-3.46; P<0.00001) when HS patients were compared with those without HS.

In view of these results, Dr Phan highlighted the need for dermatologists treating HS patients to consider integrating psychological and psychiatric support to the multidisciplinary management. The authors endorse future studies to evaluate a general screening policy in order to identify suicide risk.


    1. Menter A. Semin Cutan Med Surg. 2014;33:S54-6.
    2. Kohorst JJ, et al. J Am Acad Dermatol. 2015;73:S27-35.
    3. Shlyankevich J,et al. J Am Acad Dermatol 2014;71:1144-1150.
    4. Phan K, et al. Hidradenitis suppurativa and relationship with psychiatric comorbidities, suicides and substance abuse. P0019, EADV 2020 Virtual Congress, 29-31 Oct.
    5. Onderdijk AJ, et al. J Eur Acad Dermatol Venereol. 2013;27:473-478.
    6. Shavit E, et al. J Eur Acad Dermatol Venereol. 2015;29:371-376.


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