Hidradenitis suppurativa patients vulnerable to mental disorders

Patients with hidradenitis suppurativa (HS) face increased risks of depression and anxiety, as reported in a study.

Compared with age- and sex-matched controls without the skin condition, patients with HS had a 69-percent greater risk of new-onset depression (hazard ratio [HR], 1.69, 95 percent confidence interval [CI], 1.57–1.81; p<0.001) and 48-percent greater risk of new-onset anxiety (HR, 1.48, 95 percent CI, 1.38–1.56; p<0.001). [JAMA Dermatol 2025;doi:10.1001/jamadermatol.2025.2298]

Stratified by treatment, the risk of either depression or anxiety increased by 62 percent among HS patients on topicals (HR, 1.62, 95 percent CI, 1.41–1.85; p<0.001), 61 percent among those on systemic nonbiologics (HR, 1.61, 95 percent CI, 1.51–1.72; p<0.001), and 38 percent among those on biologics (HR, 1.38, 95 percent CI, 1.01–1.87; p<0.05).

Similarly, the risk of either mental disorder was elevated among patients who underwent HS-related surgical procedures, regardless of the resulting number of hospitalizations (0: HR, 1.44, 95 percent CI, 1.36–1.53; 1: HR, 1.66, 95 percent CI, 1.53–2.17; 2: HR, 1.59, 95 percent CI, 1.33–1.90; ≥3: HR, 1.60, 95 percent CI, 1.40–1.85; p<0.001 for all).

A significantly larger percentage of patients with HS had a history of depression (7.0 percent vs 0.3 percent; p<0.001) and anxiety (5.9 percent vs 0.5 percent; p<0.001) compared with controls. Despite this, HS patients showed no increased risk of recurrent depression (HR, 0.90, 95 percent CI, 0.62–1.28; p=0.55) or anxiety (HR, 1.22, 95 percent CI, 0.89–1.66; p=0.22).

These findings support previous research showing that individuals with HS were at increased risk of depression and anxiety compared with the general population. The risk had been seen to persist throughout a long follow-up, which could reflect the lasting burden of a chronic, inflammatory, painful, and often stigmatizing condition in the HS population. [J Invest Dermatol 2018;138:52-57; J Am Acad Dermatol 2022;86:55-60; Br J Dermatol 2024;191:351-356]

The fact that treatments and surgical procedures received by patients did not modify the risk of depression or anxiety, as observed in the present study, indicates that depression and anxiety may occur independent of disease severity, the investigators pointed out.

“Clinicians should be aware that mental health disorders can occur across all patients with HS regardless of disease severity,” they said, adding that it is important to conduct a universal psychiatric assessment and provide the necessary intervention.

The study included 10,206 patients with HS (mean age 38 years, 69.9 percent female) and 40,125 controls (mean age 37.9 years, 69.9 percent female). Compared with controls, patients with HS were more likely to have comorbidities such as diabetes (6.1 percent vs 2 percent) and hypertension (7.3 percent vs 4.6 percent) and a history of alcohol use disorder (5.8 percent vs 2.6 percent), smoking (14.0 percent vs 3.8 percent), and drug use disorder (5.1 percent vs 0.8 percent).