Quality of life considerations and pain management in hidradenitis suppurativa

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All skin diseases involve some element of stigmatization and psychosocial consequence for the individual patient, but few, if any, skin diseases can match the impact of hidradenitis suppurativa (HS) on the patient. The inflamed lesions progressing to noninflamed nodules and abscesses are not only perceived as unclean and stigmatizing by the patients, but also cause pain and scarring making this inflammatory skin disorder unique. It is obvious that the disease has a significant negative impact on the patients’ quality of life (QOL). The impact is influenced not only by the pain which is a significant independent contributor to the patients’ life quality, but by the clinically significant comorbidity associated with HS. In particular, the psychological comorbidities of depression and anxiety both further compound QOL impairment and pain. It is strongly recommended that these factors be taken into account when planning a treatment strategy for patients with HS, and that specific steps are taken to manage pain and comorbidities associated with the reduced QOL generally experienced by this group of patients. Basic pain management includes anti-inflammatory treatments as well as local- and central-acting analgesics. In more complex cases, access to consultations with a pain specialist may be necessary and may require the judicious use of antidepressants. In addition, it is recommended that patients’ QOL be addressed specifically through psychological education and patient support groups.

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