Home > Hidradenitis suppurativa: beware of psychiatric comorbidities and suicidal ideation

Hidradenitis suppurativa: beware of psychiatric comorbidities and suicidal ideation

Presented by
Dr Kevin Phan, Liverpool Hospital, Sydney, Australia
EADV 2020
An Australian meta-analysis found that patients with hidradenitis suppurativa (HS) have meaningfully increased risk for several psychiatric disorders as well as for substance and alcohol abuse.

The chronic inflammatory skin disease HS has already been linked to risk factors such as smoking, obesity, and metabolic syndrome. It not only presents as a disorder of hair follicles but can also have systemic manifestations. As there have already been indications that chronic inflammatory skin diseases could be connected to psychiatric disorders, Dr Kevin Phan (Liverpool Hospital, Sydney, Australia) and colleagues were interested in a possible association of HS with psychiatric comorbidities like depression, schizophrenia, or suicidal tendency [1]. They also looked at alcohol and substance abuse. The researchers performed a meta-analysis of studies identified by an electronic database search and direct review of articles together data about cases and controls.

As for 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, the authors highlight the need for dermatologists treating HS patients to consider integrating psychological and psychiatric support to the multidisciplinary management. They endorse future studies to evaluate a general screening policy in order to identify suicide risk.


    1. Phan K, et al. Hidradenitis suppurativa and relationship with psychiatric comorbidities, suicides and substance abuse. P0019, EADV Virtual, 29-31 October 2020.



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