Internalized skin bias reduces quality of life in patients with hidradenitis suppurativa

Patients with hidradenitis suppurativa who reported internalized skin bias were also likely to report anxiety, depression and impaired overall quality of life, according to a study.

“Hidradenitis suppurativa (HS) is a chronic autoinflammatory disease that is highly associated with affective disorders such as depression and anxiety,” Melissa Butt, DrPH, of the department of public health sciences at the Pennsylvania State University College of Medicine in Hershey, Pennsylvania, and colleagues wrote.

According to the researchers, studies have demonstrated that patients with HS may also experience high levels of internalized skin bias (ISB), and because these patients may redirect social stigmas associated with their disease internally, they may experience worse mental health outcomes and health-related quality of life (HRQOL).

In the cross-sectional study, Butt and colleagues assessed associations between ISB and other outcome measures in HS to determine if ISB may be a mediator of mental health outcomes.

Eligible participants completed an online survey pertaining to these topics between April 1 and July 15, 2021.

Results from the 230 patients (mean age, 39.2 years; standard deviation [SD], 11.2 years; 90.9% women; 88.7% non-Hispanic; 77.7% white) who completed the survey were analyzed using Internalized Skin Bias Questionnaire (ISBQ), Burns Anxiety Inventory, the Beck Depression Inventory II and the Hidradenitis Suppurativa Quality of Life instrument.

Results showed that 56.5% of the cohort reported scores qualifying as moderate or greater anxiety and 45.7% reported scores qualifying as moderate or greater depression.

Mean HRQOL scores were 34.5 (SD, 16.7) for the cohort, which the researchers noted indicates “strong levels of impairment.”

Turning to associations between ISB and mental health outcomes, results showed a moderate correlation between ISBQ score and depression. In addition, ISBQ score also correlated with HRQOL and anxiety.

Further data showed that the estimated impact of ISB on total adverse mental health effects was 38.7% for depression and 24.9% for anxiety.

In an analysis that adjusted for age, disease severity and disease duration, both ISB and anxiety positively predicted reductions in HRQOL.

“This cross-sectional study found that ISB was associated with adverse psychopathology and impaired HRQOL in patients with HS,” the researchers concluded. “Furthermore, ISB appears to mediate the associations of depression and anxiety with HRQOL.”