Drivers of disease severity and burden of hidradenitis suppurativa: a cross‐sectional analysis on 553 German patients

Abstract Background Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life‐defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. Method The cross‐sectional study is based on the baseline data of 553 participants of the health care research project “EsmAiL,” which was carried out as a multicenter randomized controlled trial. It included adult HS‐patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. Results Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. Conclusions HS is a severe and debilitating dermatosis. As a result of the well‐established factors involved, HS requires a multi‐causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi‐professional care. To prevent disease progression, a structured treatment plan is needed.