Background & Aims

Hidradenitis suppurativa (HS) is a chronic, progressive, debilitating, recurrent, and inflammatory skin disease characterized by painful, deep-seated, highly inflamed nodules and draining tunnels in the intertriginous areas of the body. Pain is a prominent symptom of HS and a major contributor to poor quality of life (QoL) in HS patients yet likely to be ignored. HS patients may present a neuropathic pain (NP) component resulting from chronic inflammation causing peripheral neuroplastic changes and central sensitization and therefore require additional pain assessments. Despite the enormous impact of pain in patients with HS, there is a lack of studies examining pain more closely in these patients. We aim to determine the prevalence of a NP component and related clinical characteristics in a group of patients with symptomatic HS.

Methods

The cross-sectional study was conducted in the outpatient Clinic of Dermatology and Venereology, and Physical Medicine and Rehabilitation. Demographic and clinical characteristics including age, sex, weight, body mass index, education level, marital status, smoking, disease duration, drug intake, HS severity, age of onset, number of affected regions, and number of flares during the past six months were recorded. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and vitamin B12 were noted in all patients. Pain intensity and type were evaluated using the visual analog scale (VAS), pain-DETECT questionnaire (PD-Q), Douleur Neuropathique 4 (DN4), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire, and Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANNS).

Results

A total of 67 patients were included in the study, comprising 24 female and 43 male participants. The average age of the patients was 34.01±11.34 years with a mean body mass index (BMI) of 28.46 kg/m². Most patients were married, and 68.7% had graduated from high school or university. 71.6% of the participants were smokers and 32.8% of them had comorbid diseases such as hypertension, diabetes mellitus, and hyperlipidemia. The ratio of patients according to Hurley staging was detected as 29.7% in Hurley I, 21.6% in Hurley II, and 48.6% in Hurley III, respectively. The mean duration of HS and lag time of diagnosis were 7.1 years and 12.55 years, respectively. The mean values of ESR, CRP and vitamin B12 were 26.5, 19.1, and 212.9 respectively.
Depending on the questionnaire scores, 79.1%, 70.1%, and 70.1% of patients were diagnosed with neuropathic pain using LANSS (scores>12), S-LANSS (scores>12), and DN4 (scores>4) respectively. According to the pain-DETECT scoring system, 50.8 % of patients were classified with a high probability (>90%) of NP status. We indicated a statistically significant correlation between PDQ, LANSS, S-LANSS, and DN4 scores.

Conclusions

Pain has an immense impact on HS-related QoL. Effective, evidence-based pain management strategies remain an important unmet need. It is important for dermatologists to regularly assess pain in HS patients and consult other pain specialists to comprehensively treat their pain. The detection of neuropathic pain is pivotal, and a multidisciplinary approach is fundamental.

References

1.Pinter A, Kokolakis G, Rech J, Biermann MHC, Häberle BM, Multmeier J, Reinhardt M. Hidradenitis Suppurativa and Concurrent Psoriasis: Comparison of Epidemiology, Comorbidity Profiles, and Risk Factors. Dermatol Ther (Heidelb). 2020 Aug;10(4):721-734. doi: 10.1007/s13555-020-00401-y.
2.Garcovich S, Muratori S, Moltrasio C, Buscemi AA, Giovanardi G, Malvaso D, Di Stasio E, Marzano AV, Peris K. Prevalence of Neuropathic Pain and Related Characteristics in Hidradenitis Suppurativa: A Cross-Sectional Study. J Clin Med. 2020 Dec 15;9(12):4046. doi: 10.3390/jcm9124046.
3.Horváth B, Janse IC, Sibbald GR. Pain management in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015 Nov;73(5 Suppl 1):S47-51. doi: 10.1016/j.jaad.2015.07.046. PMID: 26470616.
4.Savage KT, Singh V, Patel ZS, Yannuzzi CA, McKenzie-Brown AM, Lowes MA, Orenstein LAV. Pain management in hidradenitis suppurativa and a proposed treatment algorithm. J Am Acad Dermatol. 2021 Jul;85(1):187-199.

Presenting Author

Aysegul Yaman

Poster Authors

Aysegul Yaman

MD

Ankara Etlik City Hospital Physical Medicine and Rehabilitation Hospital

Lead Author

E-mail

Pelin E?me

Clinic of Dermatology and Venereology, Özel Dr. Hakan ERB?L Ümitköy Poliklini?i

Lead Author

E-mail

Ercan Çal??kan

Department of Dermatology and Venereology, Gülhane Training and Research Hospital

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral