Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study

Dermatology. 2023;239(3):445-453. doi: 10.1159/000529194. Epub 2023 Jan 26.

Abstract

Background: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS.

Objectives: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it.

Methods: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study.

Results: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis.

Conclusions: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

Keywords: Hidradenitis suppurativa; Internalized stigma; Psychodermatology; Quality of life.

Publication types

  • Multicenter Study

MeSH terms

  • Cross-Sectional Studies
  • Female
  • Hidradenitis Suppurativa* / psychology
  • Humans
  • Male
  • Pain / etiology
  • Prospective Studies
  • Quality of Life / psychology
  • Severity of Illness Index