Hidradenitis suppurativa and psychiatric comorbidities, suicides and substance abuse: systematic review and meta-analysis

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the hair follicles, and has been associated with a multitude of systemic disorders and pathologies. There is increasing evidence to suggest that chronic inflammatory skin disorders may be associated with psychiatric comorbidities, however this relationship has not been well established. We aimed perform a systematic review and meta-analysis to assess the association between HS and psychiatric comorbidities, suicide and substance abuse. Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. Results: HS cases had a significantly higher odds of having schizophrenia compared to the control group (OR 1.66, 95% CI: 1.53-1.79, P<0.00001). There was also a significant association with bipolar disorders (OR 1.96,95% CI: 1.65-2.33, P<0.00001), depression (OR 1.75, 95% CI: 1.44-2.13, P<0.00001), anxiety (OR 1.71, 95% CI: 1.51-1.92, P<0.00001), and 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), substance-related disorders (OR 2.84, 95% CI: 2.33-3.46, P<0.00001), and alcohol abuse (OR 1.94, 95% CI: 1.43-2.64, P<0.0001). Conclusions: For dermatologists treating patients with HS, screening for these comorbidities, psychiatric referral and adequately managing pain will improve the overall wellbeing of patients.