Cumulative life course impairment: Evidence for hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS) adversely affects quality of life, education, work, relationships and mental health. The debilitating effects of HS can compound over a patient's lifetime and have lasting repercussions. The cumulative life course impairment (CLCI) model analyses the disease factors that could affect the life course trajectory of a patient, including effects on major life decisions and opportunities, such as relationships, career path, education and starting a family. As with other diseases, direct longitudinal data for CLCI would require large long cohort studies. Nonetheless, the evidence supports that common domains delineated in the CLCI document impact that are consistent with the negative impact of HS on life course.

Hidradenitis suppurativa (HS) severely affects quality of life, work, relationships and mental health. The cumulative life course impairment (CLCI) model highlights how HS disrupts key life decisions. While long‐term studies are needed, evidence suggests certain factors may help protect patients from these impairments.

Why was this study undertaken?

The cumulative effects of hidradenitis suppurativa (HS) on factors that contribute to patients' life courses are likely detrimental.

What does this study add?

Age of onset, severity of the disease and associated comorbidities occur at a time that can affect educational attainment, formation of relationships and career trajectory.

What are the implications for disease understanding and clinical care?

Intervening early and aggressively to control the progression of HS may help mitigate some of the negative life course impairment effects of HS.

INTRODUCTION

Cumulative life course impairment (CLCI) is a holistic model that evaluates the impact of a disease and its associated factors on an individual's life course and major life‐changing decisions (MLCDs). Children, adolescents and young adults are particularly susceptible to disease impacts that influence their life course, as MLCDs are made during these formative years. ¹ , ² , ³ , ⁴ Young adult patients with chronic or life‐threatening diseases achieve fewer milestones in all course‐of‐life domains. ⁴ This CLCI paradigm has been applied to chronic conditions, such as paediatric malignancies, endometriosis, ⁵ and psoriasis ⁶ to analyse the disease impacts that could affect the life course trajectory of a patient, including effects on major life decisions and opportunities, such as relationships, career path, education and starting a family. ⁴

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin condition with an estimated population prevalence of 0.4%, commonly affecting young adults and it has a predilection for females, affecting them about twice as frequently as males. ⁷ , ⁸ , ⁹ Patients with HS may experience debilitating pain and social stigmatization that can have lasting repercussions. ¹⁰ Here we review the evidence for multiple life course domains, including work impairment, educational attainment, sexual health, quality of life and we apply the CLCI framework to the impact of HS on a patient's life course.

METHODS

To identify the studies evaluating the risk and protective factors that affect the life course of patients with HS, we searched PubMed, EMBASE and Cochrane Library between January 2023 to February 2024, with the following keywords and related MeSH terms: “hidradenitis suppurativa”, “HS”, “acne inversa” AND “employment”, “career”, “work”, “productivity”, “salary”, “disability”, “social life”, “presenteeism”, “absenteeism”, “employment”, “productivity”, “education”, “sexual health”, “relationship”, “marriage”, “quality of life”, “pregnancy”, “infertility” and “quality of life” “anxiety”, “depression”, “mental health”, “suicide”, “schizophrenia”, “protective”, “surgery” and “bipolar”. Two authors independently reviewed the articles to make sure they were relevant to the subject. Conference abstracts and meeting presentations were also included. 2064 records were identified. A total of 1990 articles, including those published in languages other than English, duplicates and articles deemed irrelevant, were excluded from the review. A total of, 74 articles were included (Figure 1). Demographic information, design, sample size, data quality and outcomes were recorded from the studies. The authors summarized the findings in tables, which include the following: Author/year of publication, study type/sample size, country of study, key evidence and quality assessment (see Tables 1, 2, 3, 4, 5). Each study underwent quality assessment independently by two authors. The quality assessment utilized the Newcastle‐Ottawa Scale (NOS) for cross‐sectional studies, which allows for a maximum of 2 points for the Aim, 8 points for Selection, 2 points for Comparability and 4 points for Outcome. For case–controls and cohorts studies, the assessment included a maximum of 4 points for Selection, 2 points for Comparability and 3 points for Outcome (see Table S1).

FIGURE 1.

PRISMA diagram of literature review.

TABLE 1.

Employment, disability and education (14 articles).

Author (year)	Study type (size)	Country	Evidence	Quality
Jfri et al. (2022)	Cross‐sectional (131)	Canada	Absenteeism was reported in 43.14% with mean missed workdays of 1.76 (SD 2.11). Presenteeism was reported in 77.45% with mean 5.13 days (SD 5.11). Hurley staging was significantly associated with bothered workdays (r = 0.28, p < 0.001).	Good
Kashetsky et al. (2022)	Cross‐sectional (537)	International	Negative effect on the ability to work and attend school in 81% of HS patients, with missing at least 2 days of work a month in 59% and missing > 11 days of work in 16%.	Good
Van Straalen et al. (2021)	Cross‐sectional (843)	Netherlands	Employment rate of 62% (523/843) in HS patients. 26% of working patients reported actual work time missed. In the multivariate regression models, EuroQol–5 Dimensions, pain and dermatology life quality index (DLQI) score had significant correlation with at‐work productivity loss and presentism.	Good
Yao et al. (2020)	Cross‐sectional (100)	Denmark	60.4% loss of work productivity and 21.2% missing work during the preceding week were reported by employed HS patients (57%). A 26.6% overall work productivity reduction. The WPAI outcomes; presenteeism, activity impairment and overall work impairment had moderate correlations with disease severity (r = 0.35–0.46). The mean rank of activity impairment in HS patients gradually increases along with disease severity, 34.8 in Hurley stage I, 60.1 in Hurley stage II and 64.0 in Hurley stage III, p < 0.0001.	Good
Sandhu et al. (2020)	Cross‐sectional (51)	Canada	Absenteeism was reported in 12 out of 40 employed HS patients (14.5 ± 27.0% of their working time). Mean working impairment was reported 30.1 ± 31.3%. TWPI and TAI increased with HS severity (F = 7.145, p < 0.05), with mean TWPI of 16.3 ± 25.6%, 36.0 ± 30.3%, 62.0 ± 31.5% for Hurley Stage I, II and III, and TAI, 28.9 ± 33.0%, 54.4 ± 34.8%, 61.1 ± 30.1% for Hurley Stage I, II and III, respectively (F = 3.236, p < 0.05). The high work and activity impairment scores remained significant in HS patients (p < 0.01) when stratified by depression and anxiety.	Good
Matusiak et al. (2009)	Cohort (54)	Poland	HS‐related work absence of 58.1% was reported. One to 10 times annual work absences were reported (mean, 2.9 ± 2.4 times). The mean duration reported as 33.6 ± 26.1 days (range, 3–96 days). 10% were dismissed from work due to work impairment. 23.3% were unable to be promoted secondary disease‐related obstacles; in 2 years follow up.	Good
Theut Riis et a. (2017)	Cross‐sectional (608)	Denmark	383 respondents an unemployment rate of 25.1% compared to the 6.2% in the general population in 2014. The unemployed population had a significantly higher DLQI (11.63) than employed (7.2) (p < 0.0001).	Good
Gáspár et al. (2021)	Cross‐sectional (200)	Hungary	Every year, 26 and 63 workdays were missed on average by HS patients secondary to absenteeism and presenteeism respectively.	Good
Tzellos et al. (2019)	Retrospective cohort (6018)	US	HS patients with smaller income growth (p < 0.05) and lower annual income than the controls ($54,925 vs. $62,357, p < 0.0001). The newly diagnosed HS patients with a higher risk of leaving the workforce (adjusted HR 1.65, 95%CI 1.45–1.88) and general patients had more total days lost from work (18.4 vs. 7.7) compared to controls (p < 0.001).	Good
Schneider‐Burrus et al. (2022)	Cross‐sectional (481)	Germany	HS patients with unemployment rate of 12.6%, 2 times higher than the general population. Patients had an average duration of 39.3 days of medical leave in a six‐month period. The mean HS‐related absenteeism was 13.3% (95%CI 0.7–16.8) and presenteeism was 25.2% (95% CI 21.8–28.6) and was associated with disease severity. The patients WAI‐23 questions questionnaire was about 20% lower than average German employee. Higher individual annual total indirect costs (disability and medically related absenteeism costs) in HS patients compared to controls ($2925 vs. $1483).	Good
Kearney et al. (2024)	Cross‐sectional (335)	International	HS patients reported to have received more education than their parents (p < 0.001). They reported 24% unemployment and 15.2% reliance on illness benefits. HS patients in the United States (p < 0.001), the United Kingdom (p < 0.001) and Ireland (p = 0.003) were more likely to be jobless/rely on illness benefit compared to national statistics, despite similar education in United Kingdom (p = 0.0153) and higher education in the United States (p = 0.003) and Ireland (p = 0.006).	Good
Deckers et al. (2016)	Cross‐sectional (3147)	Netherlands	46% of HS population had a low SES versus 45% in psoriasis and 32% in eczema that were chosen for control group. In the direct comparison, the SES of patients with HS remained significantly lower than control.	Good
Hamzavi et al. (2017)	Review Article (5 trials)	United States	Higher scores for TWPI were reported by patients struggling with HS than psoriasis (35.4 vs. 18.2).	N/A a
Kokolakis et al. (2020)	Cross‐sectional (394)	Germany	Patients with a longer delay in HS diagnosis reported the inability to work and number of days being work disabled more frequently than those that had a shorter delay in diagnosis.	Good

Abbreviations: SES, socioeconomic status; TWPI, total work productivity impairment; WAI, work ability index; WPAI, work productivity and activity impairment.

^a Studies outside of the cross‐sectional, cohort and case–control designs were excluded from quality assessment to ensure methodological consistency and reliability in evaluating observational data.

TABLE 2.

Relationships (26 articles).

Author (year)	Study type (size)	Country	Evidence	Quality
Cuenca‐Barrales et al. (2020)	Cross‐sectional (386)	Spain	71.4% negative impact on relationships. Among single patients, 94.3% of women and 80.8% of men stated that their sexual relationship is negatively impacted by HS. Almost half reported feeling fear of rejection, mainly due to insecurity and physical appearance, especially younger patients (OR 1.05, 95% CI 1.02–1.08, p < 0.05), single patients (OR 7.72, 4.24 14.06, p < 0.05) and the number of areas affected by scars (OR 1.14, 1.02–1.28, p < 0.05).	Good
Thompson et al. (2022)	Cross‐sectional (873)	US	60.9% of relationships were affected by HS, 49.1% because of sexual encounters with their spouse. 43.0% reported feeling reluctant to discuss HS with their spouse/significant other. 84.7% of them mentioned fear of partner seeing boils and scars is the main reason.	Good
Kurek et al. (2012)	Case–control (85)	German	FSFI score was significantly lower in HS female than without (22.1 ± 10.2 vs. 29.0 ± 8.2, p = 0.01). IIEF score was significantly lower than control (42.6 ± 27.1 vs. 62.6 ± 10.8, p = 0.01). The FKKS SSEX score, used for both genders showed significantly lower values versus control (mean ± SD 21.4 ± 5.7 vs. 27.7 ± 4.6, p < 0.01), suggesting higher sexual distress in HS patients. FKKS SSEX score significantly lower in the female versus male. (mean ± SD 19.5 ± 5.1 vs. 23.5 ± 5.8, p =0.02)	Good
Slyper et al. (2018)	Retrospective cohort (40,585)	United States	SD incidence is higher in men. However, SD among both men (OR 1.31, 95% CI 1.18–1.46) and women (OR 1.45, 95% CI 1.30–1.62) similarly had significant association with HS. A similar association was seen among patients with depressive disorder (OR 1.26, 95% CI 1.13–1.41 vs. control: OR 1.50, 95% CI 1.35–1.66) and anxiety disorder (OR 1.17, 95% CI 1.04–1.32 vs. control: OR 1.55, 95% CI 1.41–1.71).	Good
Cuenca‐Barrales et al. (2022)	Cross‐sectional (62)	Spain Poland	40.6% of women and 63.3% of men experienced sexual and erectile dysfunction. 58.8% of male partners had a high prevalence of erectile dysfunction, compared to 9.1% in female partners with sexual dysfunction.	Good
Cuenca‐Barrales et al. (2019)	Cross‐sectional (393)	Spain	High prevalence of sexual dysfunction in 51% (95% CI 45–57%) of females and 60% (95% CI 49–70%) of males with HS. Factors significantly associated with SD, as indicated by FSFI‐6 scores, included a higher level of education, the patient's global assessment, the numeric rating scale for pain and unpleasant odour and the absence of a stable relationship. Increasing age, the presence of active lesions in the genital area and a higher number of affected areas with active lesions were significantly associated with an increased risk of ED.	Good
Prens et al. (2019)	Prospective Cohort (39)	Netherland	The mean ASEX score at baseline for both genders were 15.4 ± 4.5 points. Remained the same, 6 months post STEEP with no improvement.	Fair
Janse et al. (2017)	Multicenter cross‐sectional (300)	Netherland	Compared to sexual health scores reported for healthy women in the literature (FSFI 31.2 ± 3.9, ASEX 13.5 ± 3.9), the scores of patients with HS were notably lower (FSFI 21.6 ± 9.6, ASEX 17.4 ± 5.2). Similarly, the sexual health for male patients (IIEF 49.7 ± 20.7, ASEX 14.0 ± 4.7) were lower than healthy men (IIEF 54.5 ± 13.6, ASEX 13.5 ± 3.9), with a high prevalence of ED. The ASEX score was significantly higher in women compared to men (17.4 ± 5.2 vs. 14.0 ± 4.7, p < 0.001), indicating worse sexual health. Overall, 42% of the patients met the criteria for SD. The ASEX score showed women experience significantly worse sexual health compared to men (17.4 ± 5.2 vs. 14.0 ± 4.7, p < 0.001).	Good
Alavi et al. (2018)	Cross‐sectional (100)	Canada	72% reduction in QoL was observed in male HS patients with SD and ED. For female patients, predicted a 46% variation, independent of disease severity. No correlation between changes in DLQI or any sexual function and the presence of genital lesions in either gender.	Good
Sampogna et al. (2016)	Cross‐sectional (4994)	Europe	Sexual impairment secondary to skin disease by HS patients particularly higher in patients with HS (66.7%) than other skin disease prurigo (41.7%), blistering disorders (34.9%) and psoriasis (34.8%), urticaria and eczema (both at 29.0%), infections of the skin (27.7%) and pruritus (27.6%).	Good
Marasca et al. (2020)	Cross‐sectional (70)	Italy	FDLQI score of relatives is associated with the DLQI score of patients (r = 0.88; p < 0.01) and their Hurley stage (r = 0.69; p < 0.05). Partners or spouses reported a higher FDLQI compared to parents (respectively 10.83 and 8.12; p < 0.01).	Fair
Ramos‐Alejos‐Pita et al. (2020)	Cross‐sectional (54)	Spain	FDLQI of 10.48 (range 0–30) with an association between patients' DLQI (r = 0.66, p < 0.0001).	Fair
Włodarek et al. (2020)	Cross‐sectional (50)	Poland	Association between FDLQI and partner disease severity found using both Hurley stage and HSSI (r = 0.3314, 0.4653 and p = 0.0187, 0.0007, respectively).	Fair
Tzur Bitan et al. (2021)	Cross‐sectional (25,132)	Israel	HS associated with infertility across all reproductive age groups for both males and females with a particularly strong association in individuals aged 36–45 (OR 4.50, 95% CI 2.55–7.93, p < 0.001) and in female patients (OR 3.10, 95% CI 2.57–3.74, p < 0.001). The significant association persisted only in female patients after adjusting for demographic and clinical factors. Infertility rate is higher in female HS patients compared to controls (OR 1.26 95% CI 1.04–1.55, p < 0.05)	Good
Masson et al. (2023)	Cross‐sectional (312)	USA	66.6% reported being pregnant before and 79.5% had tried to get pregnant before. 41.5% had unsuccessfully attempted to conceive for 12 months or more.	Good
Adelekun et al. (2020)	Cross‐sectional (59)	United States	49% been pregnant at some point, while 9% experienced difficulties conceiving despite trying for 12 months. 12% indicated that they had undergone fertility treatments. 73%, agreed with the statement, ‘HS negatively impacts my sexual health’. 24% felt that HS interferes with their ability to conceive due to reduced sexual activity or the potential effects of HS medications on fertility. 49% believed that pregnancy necessitates discontinuation of all HS medications for safety reasons. Concerns about the potential for their child to inherit HS were expressed by 68%. 20% were apprehensive about risks to the child from HS, including transmission or infection during vaginal delivery. Among those with HS affecting the vulva and groin, 22% were concerned that childbirth might be more challenging, while 14% who had HS affecting the breast were worried about difficulties with breastfeeding.	Fair
Garg et al. (2018)	Cross‐sectional (2299)	United States	Prevalence of PCOS is higher in HS patients than those without HS (9.0% vs. 2.9%; p < 0.0001)	Good
Phan et al. (2019)	Meta‐analysis (5 studies)	United States and United Kingdom	Patients with HS significantly more likely to have PCOS compared to controls (OR 2.64, 95% CI 1.69–4.11, p < 0.00001)	N/A a
Sakya et al. (2022)	Retrospective cohort (6063)	United States	Pregnant HS patients significantly lower odds of having a live birth (OR 0.45, 95% CI 0.39–0.51) and higher odds of elective terminations (OR 2.51, 95% CI 2.13–2.96), gestational HTN (OR 1.44, 95% CI 1.12–1.84) and caesarean sections (OR 1.28, 95% CI 1.06–1.55).	Good
Fitzpatrick et al. (2022)	Retrospective cohort (66,080)	US	HS patients found HS pregnancies had higher risk of spontaneous abortion (15.5% vs. 11.3%), preterm birth (9.1% vs. 6.7%) and were independently associated with spontaneous abortion (OR 1.2, 95% CI 1.04–1.38), gestational DM (OR 1.26, 95% CI 1.07–1.48) and caesarean section (OR 1.09, 95% CI 1.004–1.17) compared to controls	Good
Althaghafi et al. (2021)	Retrospective cohort (13,792,544)	US	HS patients had higher likelihood of preeclampsia (OR 1.36, 95% CI 1.08–1.71), delivering by caesarean section (OR 1.78, 95% CI 1.56–2.02) and having a baby with congenital anomalies (OR 2.00, 95% CI 1.10–3.62)	Good
Lyons et al. (2020)	Retrospective cohort (202)	United States	HS severity was not significantly associated with rate of live birth (p = 0.59), likelihood of C‐section (p = 0.66) or increased risk of gestational hypertension (p = 0.080), preeclampsia (p = 0.53), pregnancy complication (p = 0.92) or neonatal complication (p = 0.23). Having HS lesions on the breast was significantly associated with not breastfeeding (p = 0.004).	Good
Seivright et al. (2022)	Meta‐analysis (8 studies)	United States	24% (95% CI 0.13–0.40) of pregnant HS patients had improvement in HS, 20% worsened (95% CI 0.11–0.34) and 60% had a flare in the post‐partum period.	N/A a
Prens et al. (2021)	Retrospective survey(83)	United States and Netherland	45% of HS patients reported disease improvement during pregnancy, 26% had no change and 30% worsened. Improvement was found earlier in pregnancy (35.5% in first trimester) and worsened later in pregnancy (41% in third trimester).	Good
Voseen et al. (2017)	Cross‐sectional (168)	Netherland	Improvement in HS symptoms in 30.2% of patients and no change in 53.1% of patients during pregnancy. Amelioration during pregnancy was more frequently reported by patients who had perimenstrual flares (p = 0.01).	Fair
Lyons et al. (2020)	Retrospective cohort (202)	United States	HS patients reported HS worsened in 61.9% of pregnancies but dermatologists were involved in managing HS during the pregnancy in only 14.4% of patients.	Good

Abbreviations: ASEX, Arizona sexual experience scale; DLOQ, dermatology life quality index; ED, erectile dysfunction; SD sexual dysfunction; FDLQI, family dermatology life quality index; FKKS SSEX, Frankfurt self‐concept scale for sexuality; FSFI, female sexual function index; IIEF, International index of erectile function; IIEF‐5, International index of erectile dysfunction; QoL, Quality of Life; SD, sexual dysfunction; STEEP, skin‐tissue‐sparing excision with electrosurgical peeling.

^a Studies outside of the cross‐sectional, cohort and case–control designs were excluded from quality assessment to ensure methodological consistency and reliability in evaluating observational data.

TABLE 3.

Mental health (20 articles).

Author (year)	Study type (size)	Country	Evidence	Quality
Machado et al. (2019)	Meta‐analysis (40,307)		Prevalence of depression of 16.9% (95% CI, 9.9%–27.2%). HS patients had higher odds of depression compared to those without HS (OR = 1.84, 95% CI, 1.57–2.15). The prevalence of anxiety was 4.9% (95% CI, 1.7%–13.2%).	N/A a
Patel et al. (2020)	Systematic review (27 studies)		The prevalence and odds of depression (26.5%vs. 6.6%) (OR 2.54; 95% CI 2.15–3.01) and anxiety (18.1% vs. 7.1%) (OR 2.0; CI 1.66–242) to be higher in HS patients than those without HS.	N/A a
Phan et al. (2020)	Meta‐analysis (12 studies)		Significant association in HS patients compared to controls for depression (OR 1.75, 95% CI: 1.44–2.13, p < 0.001), anxiety (OR 1.71, 95% CI: 1.51–1.92, p < 0.001), personality disorders (OR 1.50, 95% CI: 1.18–1.92, p = 0.001), suicide (OR 2.08, 95% CI: 1.27–3.42, p = 0.004) and substance‐related disorders (OR 2.84, 95% CI: 2.33–3.46, p < 0.001), HS patients have significantly higher odds of schizophrenia (OR 1.66, 95% CI: 1.53–1.79, p < 0.00001) and bipolar disorder (OR 1.96,95% CI: 1.65–2.33, p < 0.00001) compared to control group.	N/A a
Jalenques et al. (2020)	Meta‐analysis (40 studies)		A prevalence of 21% (95% CI [17–25]) of depression and 12% (95% CI [6–17]) of anxiety in patients with HS. An association between depression and HS (OR 1.99 95% CI [1.63–2.43]) and between anxiety and HS (OR 1.97 95% CI [1.65–2.35] was demonstrated.	N/A a
Rymaszewska et al. (2023)	Cross‐sectional (115)	Poland	Prevalence of depression and anxiety of 41.2% and 40.4% with no difference between both sex groups. A significant correlation (r = 0.197, p = 0.039) between GAD‐7 scores and duration of the disease was noted.	Good
Kingston et al. (2023)	Cross‐sectional (1,353,429)	United States	No association between psychological distress (K6) scores (β = −0.243, 95% CI −1.316 to 0.830, p = 0.599) or mental disorder (MNHLTH scores) and HS patients' race (β = −0.063, 95% CI −0.196 to 0.070, p = 0.726).	Good
Sampogna et al. (2020)	Cross‐sectional (298)	Italy	Patients with mild‐to moderate HS disease activity have demonstrated lower physical and mental health scores than the general population	Good
Akoglu et al. (2021)	Cross‐sectional (63)	Turkey	Stigmatization score statistically significantly increased with HS severity and psychological distress.	Good
Singh et al. (2023)	Survey (67)	United States	Patients with HS who experience higher levels of stigmatization (FoS) tend to report significantly worse QoL, elevated depression levels and increased social anxiety. Specifically, those with greater FoS exhibit a mean QoL score of 18.1, compared to 6.7 in those with less FoS (p < 0.001). Similarly, their average depression score is 11.1, while those with lower FoS score 4.9 (p < 0.001). Additionally, the mean social anxiety score for patients with higher FoS is 30.1, contrasted with 23.2 in those with lower FoS (p < 0.001)	Fair
Kouris et al. (2016)	Case–control (188)	Greece	Compared to healthy controls, patients with HS were found to have significantly higher depression (5.45 ± 2.79 vs. 4.16 ± 1.54, p < 0.001), loneliness and social isolation (42.86 ± 8.63 vs. 35.57 ± 6.17, p < 0.001), and lower self‐esteem (18.91 ± 1.79 vs. 19.77 ± 2.53, p = 0.008)	Good
Tiri et al. (2018)	Retrospective case–control (133)	Finland	Paediatric HS patients also experience increased prevalence of psychiatric conditions compared to controls before the age of 18 (15.7% vs. 5.6%)	Good
Write et al. (2022)	Cross‐sectional (39,302)	USA	HS patients found depression to be higher in both adults (30%, 95% CI 29.6–30.5 vs. 16.9%, 95% CI 16.7–17.1) and paediatric patients (11.7%, 95% CI 10–13.7 vs. 4.1%, 95% CI 3.6–4.7). Adult HS patients had significantly higher odds of depression (1.26 times higher, 95% CI 1.25–1.28, p < 0.001) than controls, which was similar in paediatric patients (1.42 times higher, 95% CI 0.999–2.01, p = 0.051).	Good
Seivright et al. (2021)	Cross‐sectional (73)	United States	29% (21/73) prevalence of paediatric HS patients with anxiety or depression. Much higher proportion than previously reported.	Good
Patel et al. (2019)	Cross‐sectional (87,053)	United States	Of HS patients that were hospitalized, mental health disorders were more common in HS patients than those without (34.27% vs. 20.05%), but HS was not associated with primary hospitalization of a mental health disorder (odds ratio 0.95, 95% confidence interval 0.84–1.07)	Good
Alya et al. (2023)	Case–control (147)	Saudi Arabia	Compared to patients with atopic dermatitis and psoriasis, HS patients had significantly higher DLQI and depression scores (p < 0.05) and a lower percentage of employed participants (p < 0.05)	Good
Phan et al. (2020)	Meta‐analysis (4 studies)		There is an association between HS and suicides (OR 2.11, 95% CI 1.43–3.12, p = 0.0002) compared to controls.	N/A a
Ortiz‐Álvarez et al. (2022)	Cohort (136)	Spain	21.2% suicidal ideations in HS patients, higher than the Spanish average (<5%). The risk significantly associated with a history of psychiatric disorder (OR = 2.586, 95% CI 1.04–6.41, p = 0.040) and history of biologic treatments, an indication for more severe disease (OR = 2.867, 95% CI 1.004–8.182, p = 0.049)	Good
Tzur Bitan et al. (2020)	Cross‐sectional (25,132)	Israel	Higher proportion of bipolar disorders compared to controls (0.7 vs. 0.1%). HS was independently and positively associated with bipolar disorders (OR 2.12, 95% CI 1.21–3.27, p < 0.01) but the association was not significantly when controlling for body mass	Good
Tzur Bitan et al. (2020)	Cross‐sectional (25,132)	Israel	There was an increase in prevalence of schizophrenia in HS patients compared to controls (1.4% and 0.4%, respectively, p < 0.001)	Good
Kluger et al. (2019)	Cohort (167)	Finland	4.8% and 3.6% prevalence for bipolar disorder and schizophrenia respectively in HS patients.	Good

Abbreviation: FoS, feelings of stigmatization.

^a Studies outside of the cross‐sectional, cohort and case–control designs were excluded from quality assessment to ensure methodological consistency and reliability in evaluating observational data.

TABLE 4.

Quality of Life (11 articles).

Author (year)	Study type (size)	Country	Evidence	Quality
Montero‐Vilchez et al. (2021)	Meta‐analysis (4929)	Spain	Mean DLQI of 10.70 (SD 2.16) for HS patients. High pain values, pruritus and malodor are associated with higher DLQI scores in these patients. The NRS pain due to HS in was 3.99 (0.95), NRS pruritus 4.99 (0.96) and NRS malodor ranged from 3.28 to 5.6 and incidence of pruritus ranged from 41.7% to 61.8% with factors associated including Hurley III, higher number of regions affected, the female sex, being an active smoker, the intensity of drainage and pain, having Crohn's disease and not using statin	N/A a
McKenzie et al. (2020)	Cross‐sectional (145)	US	Hurley stage III significantly higher mean DLQI scores (20.2) compared to those with Hurley stage I (11.3) and stage II (13.9), (p < 0.001). After adjusting for Hurley stage, no significant differences in mean DLQI scores based on gender (women vs. men), race (non‐white vs. white), weight (obese with BMI ≥30 vs. non‐obese) or functional status (disabled vs. non‐disabled). Disease severity associated with severity for odour (correlation coefficient 0.4, p < 0.001), difficulty moving arms (0.323, p < 0.001), negative impact on job/school (0.303, p < 0.001) and negative impact on relationships (0.298, p < 0.001)	Good
Matusiak et al. (2010)	Cohort (54)	Poland	Patients with more severe disease exhibited higher DLQI scores, with mean scores of 5.77 ± 4.59, 13.1 ± 6.41 and 20.4 ± 6.67 for Hurley stages I, II and III, respectively. A statistically significant, strong positive correlation was observed between DLQI scores and disease activity (R = 0.67; p < 0.0001). Additionally, anogenital localization significantly impacted quality of life compared to other body regions (e.g. axillae, groin, head and nape), with a p‐value of 0.0051.	Fair
Alavi et al. (2018)	Cross‐sectional (100)	Canada	HS had a significantly higher DLQI score compared with the control group (p < 0.0001). No correlation between changes in DLQI or any sexual function measures and the presence of genital lesions in either gender.	Good
Hayama et al. (2021)	Cross‐sectional (63)	Japan	DLQI was significantly correlated with PGA (p = 0.0189) and the Hurley stage (p = 0.033).	Good
Jfri et al. (2022)	Cross‐sectional (131)	Canada	Patients with an IHS‐4 score ≥3.5 were 9.4‐times more likely to have higher DLQI score.	Good
Tavora et al. (2019)	Cross‐sectional (390)	Brazil	Severe impact on quality of life (DLQI 20 [13–25]) in HS patients	Good
Senthilnathan et al. (2019)	Cross‐sectional (153)	USA	No significant difference in DLQI scoring based on Hurley classification (I: 11.7, II: 12.0, III: 14.4) The only statistically significant difference in DLQI scores by Hurley stage was between stages 0 and 3 (p < 0.05).	Good
Marasca et al. (2020)	Cross‐sectional (70)	Italy	Female patients may have higher DLQI scores than male patients with HS (15.2 vs. 10.7)	Fair
McAndrew et al. (2021)	Cross‐sectional (25)	United States	HS assessing their quality of life using Skindex‐Teen score and found an average of 45.7 (range 0–84) with increase scores with higher Hurley stage (I: 42.6, II: 49.8, III: 53.7)	Good
Hamzavi et al. (2017)	Review (5 studies)	United States	Compared with patients with psoriasis, patients with HS reported higher scores for DLQI (15.3 vs. 11.3 [p < 0.0001]), EuroQOL 5D VAS (58.8 vs. 50.8 [p < 0.0002]).	N/A a

Abbreviations: DLQI, dermatology life quality index; IHS4, International HS severity scoring system; NRS, number rating scale; PGA, physicians' global assessment.

^a Studies outside of the cross‐sectional, cohort and case–control designs were excluded from quality assessment to ensure methodological consistency and reliability in evaluating observational data.

TABLE 5.

Protecting HS Patients from CLCI (7 articles).

Author (year)	Study type (size)	Country	Evidence	Quality
Kimball et al. (2018)	Clinical trial (629)	United States Norway	Patients who achieved HiSCR were more likely than non‐responders to experience improvements in DLQI (60.5% vs. 30.4%), Pain NRS (46.9% vs. 19.9%), HSQOL (49.4% vs. 26.9%), work‐related performance (52.6% vs. 37.7%).	N/A a
Gulliver et al. (2022)	Clinical trial (138)	Canada	Moderate‐to‐severe HS patients treated with adalimumab had significant improvement in patient‐reported outcomes (p < 0.0023) and increase in work productivity and activity level by about 20% at week 24 and week 52.	N/A a
Gupta et al. (2019)	Cohort (49,606)	Canada	A signal indicating a reduced risk of SB was observed with TNF‐α antagonists (ROR = 0.1959, 95% CI 0.1247–0.3079; z = 7.071, p < 0.0001) compared to all other HS treatments.	Good
Dick et al. (2021)	Prospective cohort (55)	Germany	Preoperatively, HS patients showed a mean DLQI score of 14.5 ± 7.3, which decreased following by operation. 21 days after operation, the mean DLQI scores increased to 17.4 ± 7.2 (p = 0.004). After 3 and 6 months, the DLQI scores were 8.2 ± 7.7 and 5.8 ± 7.0. Both being significantly lower than baseline (p < 0.001). HS patients reported a perioperative pain score of 3.7 ± 2.8 points, indicative of mild pain. By day 21, pain level had reduced to 2.5 ± 2.6 points (p < 0.029). At 3‐ and 6‐months post op, pain scores were 1.5 ± 2.1 and 0.8 ± 1.7, respectively; both were significantly lower than the baseline (p < 0.001)	Good
Ravi et al. (2022)	Retrospective cohort (194)	United States	Majority of patients expressed a willingness to recommend would the surgery to a friend (163 of 194 procedures [84%]), indicated they would choose to undergo the surgery again (162 procedures [84%]), reported satisfaction with having undergone the surgery (166 procedures [86%]) and felt that the operation met their expectations (158 procedures [81%]).	Fair
Kirby et al. (2017)	Cross‐sectional (154)	United States Denmark	Depressive symptoms score was significantly correlated with the resilience score (regression coefficient a = −0.21; p < 0.001) and lower HRQOL (c' = 0.644; p < 0.001).	Good
Kontzias et al. (2023)	Cross‐sectional (67)	United States	Single and married patients reported significantly higher levels of social support compared to those who were formerly partnered, with mean scores of 25.1 and 29.9 versus 14.8, respectively (p = 0.005 and p < 0.001). Additionally, single and married patients demonstrated better QoL compared to the formerly partnered group, with mean scores of 12.8 and 8.3 versus 21.3, respectively (p = 0.024 and p < 0.001). There were no differences in disease severity among the different marital status groups.	Good

Abbreviations: DLQI, dermatology life quality index; HiSCR, Hidradenitis suppurativa clinical response; HRQOL, health‐related quality of life; HSQL, hidradenitis suppurativa quality of life; NRS, number rating scale; ROR, reporting odds ratios; SB, suicidal behaviours.

^a Studies outside of the cross‐sectional, cohort and case–control designs were excluded from quality assessment to ensure methodological consistency and reliability in evaluating observational data.

RESULTS

Data categorization and quality (Table S1)

The cross‐sectional studies (n = 45) were categorized as focusing on employment, disability and education ¹¹ ; relationships ¹⁶ ; mental health ¹⁰ ; quality of life (8, including 2 studies overlapping content with relationship) and protective factors. ²

The average Newcastle ‐Ottawa Scale quality assessments for the cross‐sectional studies were 1.7/2 for clearly stated aim, 5.9/8 for subject selection, 1.6/2 for comparability and 3/4 for outcome assessments. Some of the papers about relationships had somewhat lower scores.

The cohort studies (n = 14) were categorized as focusing on employment, disability and education, ² relationships, ⁷ mental health ² quality of life (1 common study with employment, disability and education) and protective factors. ³ The average Newcastle‐Ottawa Scale quality assessments were 3.7/4 for subject selection, 1.5/2 for comparability and 2.6/3 for outcome assessments.

The case–control studies (n = 4) were categorized as focusing on relationships, ¹ and mental health. ³ The average Newcastle‐Ottawa Scale quality assessments were 3.3/4 for subject selection, 1.8/2 for comparability and 2/3 for outcome assessments.

Evidence for cumulative life course impairment (CLCI)

Employment, disability and education

We identified 14 studies related to the effect of HS on a patient's work life and education (Table 1) Patients with HS experience higher rates of missed work, decreased productivity, lower salaries and fewer promotions compared to unaffected individuals. Unemployment rates for HS patients are consistently higher than those of the general population. HS impacts the work ability index (WAI‐23), school attendance, absenteeism (percentage of work missed), presenteeism (productivity loss at work) and total work productivity impairment (TWPI). Additionally, studies show a significant link between Hurley stage and the number of workdays affected by HS. ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸

The unemployed HS population had a significantly higher DLQI (Dermatology life quality index) scores than the employed group in a study by Theut Riis et al. ¹⁹ Van Straalen et al.'s data are also consistent with these findings. They also noted that pain, DLQI and EuroQol–5 Dimensions scores were significantly associated with presenteeism and at‐work productivity loss in multivariate regression models. Unemployed patients with HS had significantly more inguinal/gluteal HS, increased HS severity, higher pain scores, the presence of fibromyalgia and higher depression and anxiety scores. ²⁰

Patients with HS who participated in Kearney et al.'s study reported receiving more education than their parents. Despite this, they have experienced a decline in their social status, with higher unemployment rates and reliance on illness benefits as a result of a disease. The onset of the disease tends to occur during the peak years of education. The study concluded that the disease does not affect education, but accumulating health issues during working years may limit HS patients' opportunities. ²¹

Delay in diagnosis, severe disease, pain and decreased quality life scores have been associated with work productivity. ²² , ²³ , ²⁴ , ²⁵ As per Kokolakis et al., patients with a longer delay in HS diagnosis more frequently reported both the inability to work and the number of days being work disabled than those that had a shorter delay in diagnosis. ²⁶ Tzellos et al. reported that HS affects salary, income growth, work retention and promotion. Patients with HS were found to have a smaller income growth and lower annual income than the general population. They also have a higher risk of leaving the workforce and more total absence days. A calculated loss of gross value of around €12.6 billion results from the effect of HS on patients and their ability to work in Germany. ¹⁵ Higher individual annual total indirect costs (disability and medically related absenteeism costs) were detected in patients with HS compared to the general population ($2925 vs. $1483) in the United States. ¹¹ Consistent with these findings, patients with HS have a higher degree of work impairment and lower socioeconomic status (SES) compared to psoriasis patients. ²⁷ , ²⁸

Relationships, sexual health and fertility

Twenty‐six studies addressed the negative impact HS can have on patients' sexual health, fertility and relationships (Table 2).

Cuenca‐Barrales et al. extensively studied sexual health in patients with HS in Spain. Their data showed that HS affects patients' perception of their sexual health. Patients with HS feared rejection or reaction from a sexual partner more than the non‐HS population. Common reasons for fear of rejection included insecurity and physical appearance, which occurred more with younger patients in the absence of stable relationships and an increase in the number of scarred areas. Even patients in stable relationships stated that HS negatively impacted their relationships and reported that pain interfered with their sexual relationships. ²⁹

Thompson et al. also reported HS affecting multiple aspects of patients' relationships. Patients were hesitant to discuss their condition with their significant others, citing communication barriers, fear of partners being bothered by boils, scars and malodorous drainage, or thinking their symptoms were a serious infection or sexually transmitted illness. ³⁰ , ³¹

In addition to their perceptions of sexual health, HS has been associated with sexual dysfunction. Multiple studies observed patients with HS have a higher likelihood of sexual dysfunction and sexual distress compared to matched controls; females were generally affected more than males. ³² , ³³ , ³⁴ , ³⁵ , ³⁶ , ³⁷ , ³⁸ However, Slyper et al. showed that HS was significantly associated with sexual dysfunction (SD) among both men and women compared to patients of the same gender without HS, and this association did not differ significantly by sex. ³³

Sexual dysfunction (SD) in patients with HS was shown to be related to educational status, disease activity, pain scale, absence of a stable relationship and unpleasant odour. Erectile dysfunction (ED) in patients with HS was related to age, lesions in the genital area and the number of active lesions. ³⁵

Multiple studies showed that HS is significantly associated with SD in patients with mental disorders including depression and anxiety. The SD incidence was higher in those with HS and depression/anxiety compared to those without HS with these conditions. ³³ , ³⁹ Patients with HS also reported higher SD than other skin conditions (prurigo, blistering, psoriasis, urticaria or eczema). ³⁹

Janse et al. confirmed diminished quality of life (QoL) and sexual health in patients with HS. Despite QoL impairment being linked to anogenital involvement, early onset of HS, and disease severity and activity, sexual health was not correlated with any of these factors. ³⁸ Alavi et al. also confirmed that the SD contribution to QoL impairment is independent of genital lesions. ³⁷

Prens et al. evaluated the Arizona Sexual Experiences Scale (ASEX), DLQI, and measures of activity and overall work impairment in patients with HS who underwent Skin‐Tissue‐sparing Excision with Electrosurgical Peeling (STEEP). They reported that surgery did not improve sexual experiences at 6 months post‐surgery. ³⁴

Multiple studies evaluate the impact of HS on patients and their family members in terms of QoL and sexual function and the related risk factors, demonstrating that HS not only negatively affects the patients but also their family members. The Family Dermatology Life Quality Index (FDLQI) score of relatives is associated with the DLQI score of patients and their Hurley stage. Partners or spouses reported a higher FDLQI compared to parents. ED has a high prevalence among male partners, greater than the prevalence of SD in the female partners with HS. This prevalence is similar to that observed in men with HS. ³⁶ , ⁴⁰ , ⁴¹ , ⁴²

HS has also been associated with infertility. Multiple studies showed a higher infertility rate in patients with HS, which is more significant in female patients. Some of them reported that they had had unsuccessful attempts to conceive for more than a year. Patients reported that HS interfered with their ability to conceive due to reduced sexual activity or the potential effects that HS medications have on fertility. Some believed that pregnancy necessitates discontinuation of all HS medications for safety reasons. Other common beliefs included the possibility of children inheriting HS or getting infected from HS during vaginal delivery. Additionally, those with HS affecting the vulva and groin were concerned that childbirth might be more challenging, while those who had HS affecting the breast were worried about difficulties with breastfeeding. ³¹ , ⁴³ , ⁴⁴ PCOS is also independently known to be one of the leading causes of infertility, and the prevalence of PCOS is higher in HS. ⁴⁵ , ⁴⁶

HS appears to also have a negative impact on pregnancy outcomes. Investigations are consistent with a lower risk of live birth and a higher risk of spontaneous abortion, preterm birth, preeclampsia, elective terminations, gestational hypertension/diabetes and delivering by caesarean section, as well as having a baby with congenital anomalies in pregnant patients with HS. ⁴⁷ , ⁴⁸ , ⁴⁹ With one exception, Lyons et al. did not find an increased risk of poor pregnancy outcomes in patients with HS compared to the general population. ⁵⁰ Studies have inconsistent results regarding flares or improvement of HS during pregnancy. ⁵¹ , ⁵² Prens et al. noted that an improvement was found earlier in pregnancy and worsened later in pregnancy. ⁵³ Vossen et al. showed that the amelioration during pregnancy was more frequently reported by patients who had perimenstrual flares. ⁵⁴

Mental health

We found 20 studies assessing mental health in patients with HS (Table 3). Multiple studies have demonstrated that patients with HS have higher rates of depression and anxiety. ⁵⁵ , ⁵⁶ , ⁵⁷ These patients also reported more loneliness, social isolation and lower self‐esteem compared to the general population. ⁵⁸ Rymaszewska et al. also noted no difference in the prevalence of anxiety and depression between both genders with HS and observed a significant correlation between GAD and HS duration. ⁵⁹ A meta‐analysis by Phan et al. found a significant association between HS and other mental disorders, including bipolar disorders, schizophrenia, personality disorders, suicidal behaviour and substance‐related disorders, in addition to depression and anxiety. ⁶⁰ , ⁶¹ , ⁶² , ⁶³ , ⁶⁴ Patient with HS and psychiatric disorders were younger and had higher body mass index (BMI). ⁶⁴ Tzur Bitan et al.'s data showed HS is independently and positively associated with bipolar disease, but the association was not statistically significant after controlling for body mass. ⁶² Paediatric patients with HS also experience increased prevalence of psychiatric conditions, specifically depression and anxiety. ⁶⁵ , ⁶⁶ , ⁶⁷

Few studies have evaluated the prevalence of suicide among patients with HS; however, their findings are consistent with a strong correlation between HS and suicides or suicidal ideation. ⁶⁸ The risk is mostly observed in patients with a history of psychiatric disorder and those who have undergone biologic treatments, which may indicate more severe disease. ⁶⁹

HS has been associated with feelings of stigmatization which can affect social interactions and mental health. A strong relationship was found between HS severity and psychological distress and mental health disorder in patients with HS secondary to stigmatization. ⁷⁰ , ⁷¹ When evaluating factors contributing to mental health, there were no racial differences in mental health outcomes in patients with HS. ⁷² Mental health disorders were more common in hospitalized patients with HS than those without, but HS was not associated with primary hospitalization for a mental health disorder overall. ⁷³

Alya et al. evaluated DLQI, depression and employment status in chronic skin diseases, including atopic dermatitis, psoriasis and HS. They found significantly higher DLQI and depression scores as well as a lower percentage of employed participants among patients with HS compared to those with atopic dermatitis and psoriasis. ⁷⁴

Quality of life (QoL)

Eleven studies focused on QoL in patients with HS were included (Table 4).

DLQI is a frequently used patient‐reported scale with a maximum score of 30 that encompasses six domains, including symptoms and feelings, daily activities, leisure, work and school performance, personal relationships and treatment. Based on the DLQI, HS has an immense impact on patients' QoL. Multiple studies showed that the mean DLQI score for patients with HS is higher than that of the general population. Higher values of pain, pruritus, malodor and HS severity are associated with higher DLQI scores. Hurley III was found to have a significantly higher average DLQI compared to Hurley II and Hurley I. ¹⁷ , ³⁷ , ⁴⁰ , ⁵⁸ , ⁷⁰ , ⁷⁵ , ⁷⁶ , ⁷⁷ , ⁷⁸ , ⁷⁹ , ⁸⁰ , ⁸¹ , ⁸² A similar pattern was found for paediatric patients with HS. ⁸⁰ However, Senthilnathan et al. found no difference in DLQI scoring based on the Hurley classification. ⁸³

The DLQI scores are significantly higher in HS than in other chronic skin conditions, such as psoriasis. Even mild HS has a significant impact on QoL that is comparable to or exceeds that of moderate‐to‐severe atopic dermatitis and psoriasis. ²⁸ , ⁷⁶ , ⁸³ , ⁸⁴

Protecting patients with HS from CLCI

As several of the above factors are negative influences on the CLCI model, there are also factors that have a positive impact on the CLCI (Table 5).

Treatment

Efficacious long‐term management has been associated with improvement in patients' QoL. Standard medical interventions typically consist of antibiotics, hormonal therapies and biologics. Clinical trials showed that treatment with Adalimumab and Secukinumab in moderate‐to‐severe HS clinical trials resulted in improvement in DLQI, work productivity, activity impairment and HS‐pain because of treatment. ⁸⁵ , ⁸⁶ Treatment of HS with TNF‐alpha antagonists has been shown to reduce the risk of suicidal behaviours, further supporting that adequate treatment of the disease will help to improve the psychological diseases associated with HS. ⁸⁷

Surgical intervention is frequently utilized to manage recurrent nodules and fistulas. Dick et al. data showed significant improvement in QoL and pain in patients with HS post Wide Local Excision (WLE). ⁸⁸ Ravi et al. evaluated patients with HS status post‐surgical deroofing or local excision and demonstrated a high degree of satisfaction with surgery. Recovery was typically rapid, and most patients reported that postoperative pain was less severe than the pain experienced during flares. ⁸⁹ , ⁹⁰

Resilience training

A survey demonstrated that resilience moderates depression in patients with HS. ⁹¹ This may underscore the importance of patients learning resilience through therapy and training programs to decrease the impact of the disease on QoL. Providers should consider therapy and training programmes as an adjunctive option to medical management to help improve QoL.

Social support

In one study, single and married patients with HS have improved QoL and reported higher social support than those who were formerly partnered (divorced, separated or widowed). ⁹² Providers should be aware of the social support situation and can potentially provide information on national HS organizations and resources.

CONCLUSIONS

The effect of HS extends to the workplace associated with increased absenteeism, decreased work productivity and lower salaries. HS, moreover, impacts a patient's quality of life, mental health, social and sexual relationships and pregnancies. Since HS is commonly present in young adulthood, these effects can alter the trajectory of a patient's life course. The current body of literature describing components of CLCI is not large but is generally well‐conducted generally. Further longitudinal data is needed to determine which patients and factors led to greater risk for CLCI.

Moreover, delay in diagnosis and initiation of treatment has been associated with decreased responsiveness to treatments. ⁹⁰ Earlier intervention and diagnosis can help symptom and disease management, potentially mitigating some of the disease's impact on the key life milestones in a patient's life and restore some of the patient's life potential. The recent S2k guideline for treatment of HS emphasizes that treatment decisions should take into account both objective disease severity measures and the individual subjective impact on patients. ⁹³ The CLCI paradigm demonstrates the impact HS can have on multidimensional life course outcomes and reinforces the need for early identification and appropriate treatment.

AUTHOR CONTRIBUTIONS

MDT – conception and design, data acquisition, analysis and interpretation, drafting and revision; RSG and CS – conception and design, data acquisition, drafting; MLP and ABK – conception and design, revision, final approval of the manuscript.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST STATEMENT

Dr. Kimball is receiving honoraria or consulting with Abbvie, Alumis, Avalo, Boehringer Ingelheim, Eli Lilly, Evoimmune, Innovaderm, Janssen, Merck, Moonlake, Novartis, Pfizer, Priovant, Sanofi, Sonoma Bio, Target RWE, UCB, Union Therapeutics and Takeda. Dr. Kimball is on the board of directors of Almirall and the American Dermatologic Association. Dr. Kimball's institution receives grants from: Abbvie, Anapyts Bio, Aristea, Bristol Myers Squibb, Eli Lilly, Incyte, Janssen, Moonlake, Novartis, Pfizer, Prometheus, Sanofi, Sonoma Bio, UCB. Dr. Porter is a consultant and/or investigator for Abbvie, Anapyts Bio, Aristea, Bristol Myers Squibb, Eli Lilly, Incyte, Janssen, Moonlake, Novartis, Pfizer, Prometheus, Sanofi, Sonoma Bio, UCB, Regeneron, Bayer, Alumis, Avalo, Trifecta Clinical/WCG, Zurabio. Dr. Porter receives royalties from BIDMC Licensed HS training module. She is a member of the AAD Patient Safety Quality Committee, HS Foundation Research and Therapeutics Committee, and AAD DataDerm Committee. Dr. Gibson's fellowship was funded through the National Psoriasis Foundation. Dr. Doroudian Tehrani is an investigator for Abbvie, Eli Lilly, Incyte, Moonlake, Prometheus, Sanofi, Insmed, UCB and Bristol Myers Squibb. Corey Snyder has no conflicts of interest to disclose.

ETHICAL APPROVAL

This study does not require IRB approval.

ETHICS STATEMENT

Not applicable.

Supporting information

Data S1.

Doroudian Tehrani M, Gibson RS, Snyder CL, Porter ML, Kimball AB. Cumulative life course impairment: Evidence for hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2025;39:1395–1409. 10.1111/jdv.20607

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.