Association of Hidradenitis Suppurativa With Body Image

Case-control study of the body image of 46 patients with hidradenitis suppurativa

Key Points


Questions  Because hidradenitis suppurativa is associated with severe impairment of quality of life and depression, is it also associated with decreased body image?


Findings  In this case-control study, the body image of 46 patients with hidradenitis suppurativa was significantly impaired compared with that of 41 healthy control individuals and was associated with depression and anxiety but not with the severity of the disease.


Meaning  Altered body image is another element of the psychosocial distress of patients with hidradenitis suppurativa that might be linked to depression and anxiety and thus could be used as an effective outcome measure.




Importance  Hidradenitis suppurativa (HS) leads to disfigurement and painful eruptions in terminal hair follicles of the intertriginous skin, mainly of axillary, genitofemoral, and perianal sites. It is associated with an excessive impairment of quality of life, psychiatric disorders, and sexual distress. Body image impairment has been linked to depression and anxiety and has been described for some dermatologic disorders but has not yet been investigated in patients with HS.


Objectives  To investigate whether body image is diminished in patients with HS and whether disease severity, age at onset, disease duration, obesity, depression, and anxiety are linked to body image impairment.


Design, Setting, and Participants  This 12-month (August 1, 2009, to August 31, 2010) case-control study with a prospective, observational, cross-sectional design recruited 47 consecutive patients with HS entering a tertiary care center and 45 healthy control individuals matched for age, sex, and body mass index (BMI). One patient and 4 controls failed to complete the questionnaire and were excluded from the evaluation. Data analysis was performed from December 1, 2013, to February 15, 2014.


Main Outcomes and Measures  The Frankfurt Body Concept Scale (FKKS) and the Hospital Anxiety and Depression Scale (HADS) were given to patients and controls. Correlations among FKKS, HADS, and disease features were calculated.


Results  Of the 46 patients and 41 controls included in the evaluation (mean [SD] age, 35.6 [1.6] years; 40 [46%] male and 47 [54%] female), HS significantly reduced body image (mean FKKS score, 234.2 [5.4] in patients and 276.9 [5.7] in controls; P < .001), even when controlled for BMI. A correlation was found for the extent of body image disruption and BMI (r = −0.589; P < .001), HADS-depression score (r = −0.619; P < .001), and HADS-anxiety score (r = −0.340; P = .03). No association was found for the body image score and the severity of HS, age at onset of disease, and duration of disease. The body contact subscale score was the only subscale score that was not different between patients with HS and controls.


Conclusions and Relevance  Patients with HS have major body image impairment, which might lead to depression and anxiety, disorders that have been largely acknowledged in HS. This study identified another element of the psychosocial burden of patients with HS and reveals that body image could potentially be used as an outcome measure in future studies of HS.


You can read the whole article in JAMA Dermatology