1
|
Pixley JN, Kontzias C, Feldman SR, Pichardo RO. Coping Strategies Are Associated With Social Anxiety in Hidradenitis Suppurativa. J Cutan Med Surg 2023; 27:526-528. [PMID: 37489891 DOI: 10.1177/12034754231188324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Jessica N Pixley
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christina Kontzias
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rita O Pichardo
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
2
|
Butt M, Rigby A, Leslie DL, Foulke GT, Flamm A, Kirby JS, Chinchilli VM. Associations of Internalized Skin Bias With Age, Adverse Psychopathology, and Health-Related Quality of Life Among Patients With Hidradenitis Suppurativa: A Cross-sectional Analysis. JAMA Dermatol 2022; 158:432-438. [PMID: 35293961 PMCID: PMC8928088 DOI: 10.1001/jamadermatol.2022.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hidradenitis suppurativa (HS) is a chronic autoinflammatory disease that is highly associated with affective disorders such as depression and anxiety. Recent studies have shown that patients with HS may also endorse high levels of internalized skin bias (ISB). This redirection of skin disease-related social stigma toward oneself may also play an important role in the associations between adverse psychopathology (eg, depression, anxiety) and health-related quality of life (HRQOL). Objectives To evaluate the associations of ISB with other core outcomes in HS and to determine if ISB may mediate the associations between adverse psychopathological outcomes and impaired HRQOL. Design, Setting, and Participants A cross-sectional study of adult patients with HS recruited from 1 academic medical center as well as through virtual social and recruitment networks. Eligible participants completed an online survey comprised of 4 survey instruments along with demographic and disease history information from April 1, 2021, to July 15, 2021. Main Outcomes and Measures Measures included the Internalized Skin Bias Questionnaire (ISBQ), Burns Anxiety Inventory, the Beck Depression Inventory-II, the Hidradenitis Suppurativa Quality of Life (HiSQOL) instrument, along with demographic and disease history information. The primary outcome was HRQOL as measured by the HiSQOL. Data were analyzed in July through August 2021. Results The survey was completed by 230 of 279 patients (82.4%; mean [SD] age, 39.2 [11.2] years; 209 [90.9%] identified as female, 203 [88.7%] as not Hispanic, 178 [77.7%] as White). Depression and anxiety were shown to be a substantial burden in this sample, with 56.5% of participants' scores qualifying for moderate or greater anxiety and 45.7% moderate or greater depression. The mean (SD) HRQOL scores were moderately high at 34.5 (16.7), indicating strong levels of impairment. There was a moderate correlation between ISBQ score and depression (r = 0.67); and fair correlations with HRQOL (r = 0.52) and anxiety (r = 0.56). Therefore, ISB appears to positively mediate the associations between depression and anxiety (estimated proportions of total effect that were mediated, 38.7% and 24.9%, respectively) and HRQOL. After controlling for age, disease severity, and disease duration, both ISB and anxiety were positive predictors of impaired HRQOL. Conclusions and Relevance This cross-sectional study found that ISB was associated with adverse psychopathology and impaired HRQOL in patients with HS. Furthermore, ISB appears to mediate the associations of depression and anxiety with HRQOL. Future studies are needed to design interventions targeted at addressing adverse psychopathology associated with ISB and improving HRQOL and well-being for patients with HS.
Collapse
Affiliation(s)
- Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey.,Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey.,Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey
| | - Andrea Rigby
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey
| | - Galen T Foulke
- Department of Dermatology, University of North Carolina, Chapel Hill
| | - Alexandra Flamm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey
| |
Collapse
|
3
|
Butt M, Chinchilli VM, Leslie DL, Khesroh E, Helm MF, Flamm A, Kirby JS, Rigby A. Internalized skin bias: Validation study to explore the impact of the internalization of social stigma on those with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022; 36:1118-1124. [PMID: 35170818 DOI: 10.1111/jdv.18007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic auto-inflammatory disease that is highly associated with adverse psychopathology and impaired body image. Previous studies show that patients with HS are also impacted by social stigma associated with their skin disease. Over time, these experiences can influence the way in which patients feel about themselves, leading to internalized skin bias (ISB). OBJECTIVES To evaluate the validity and reliability of the Internalized Skin Bias Questionnaire (ISBQ) in an HS population, and to determine the association of this instrument with markers of HS severity. METHODS A cross-sectional survey with 72-hour retest was sent to adult patients with HS from March to November 2021. Reliability for the ISBQ was evaluated using Cronbach's alpha and the Concordance Correlation Coefficient (CCC). Construct validity was evaluated using Pearson Correlation Coefficients with similar measures. RESULTS Internal consistency for the ISBQ instrument was 0.89 with a CCC of 0.88. The ISBQ had moderate correlation (r = 0.63) with the experienced skin stigma questionnaire as well as the BDI-II (r = 0.66) and the psychosocial subscale of the HiSQOL (r = 0.65). ISBQ scores differed significantly across different stages of disease severity (p=0.04). There was no significant difference between those with different durations of disease (p=0.47). CONCLUSIONS This study shows that the ISBQ is a valid and reliable instrument that can be used to assess the psychosocial construct of ISB especially in a population of HS patients. Further, ISB places a prevalent negative impact on the psychopathology of patients with HS.
Collapse
Affiliation(s)
- Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Eiman Khesroh
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Matthew F Helm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexandra Flamm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Andrea Rigby
- Department of Surgery - Division of Minimally Invasive SurgeryPenn State Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
4
|
Rencz F, Szabó Á, Brodszky V. Questionnaire Modifications and Alternative Scoring Methods of the Dermatology Life Quality Index: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1158-1171. [PMID: 34372982 DOI: 10.1016/j.jval.2021.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/02/2021] [Accepted: 02/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Dermatology Life Quality index (DLQI) is the most widely used health-related quality of life questionnaire in dermatology. Little is known about existing questionnaire or scoring modifications of the DLQI. We aimed to systematically review, identify, and categorize all modified questionnaire versions and scoring methods of the DLQI. METHODS We performed a systematic literature search in PubMed, Web of Science, CINAHL, and PsychINFO. Methodologic quality and evidence of psychometric properties were assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and Terwee checklists. RESULTS The included 81 articles reported on 77 studies using 59 DLQI modifications. Modifications were used for a combined sample of 25 509 patients with 47 different diagnoses and symptoms from 28 countries. The most frequently studied diseases were psoriasis, hirsutism, acne, alopecia, and bromhidrosis. The modifications were categorized into the following nonmutually exclusive groups: bolt-ons or bolt-offs (48%), disease, symptom, and body part specifications (42%), changes in existing items (34%), scoring modifications (27%), recall period changes (19%), response scale modifications (15%), and illustrations (3%). The evidence concerning the quality of measurement properties was heterogeneous: 4 of 13 studies were rated positive on internal consistency, 1 of 3 on reliability, 3 of 5 on content validity, 9 of 22 on construct validity, 6 of 6 on criterion validity, and 1 of 1 on responsiveness. CONCLUSION An exceptionally large number of DLQI modifications have been used that may indicate an unmet need for adequate health-related quality of life instruments in dermatology. The psychometric overview of most questionnaire modifications is currently incomplete, and additional efforts are needed for proper validation.
Collapse
Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Hungarian Academy of Sciences, Premium Postdoctoral Research Programme, Budapest, Hungary.
| | - Ákos Szabó
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| |
Collapse
|
5
|
Wright S, Strunk A, Garg A. Prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa. J Am Acad Dermatol 2021; 86:55-60. [PMID: 34144081 DOI: 10.1016/j.jaad.2021.06.843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information on prevalence of depression among children, adolescents, and adults with hidradenitis suppurativa (HS) is limited. OBJECTIVE To compare prevalence of depression in HS patients with that of controls. METHODS Cross-sectional analysis of 38,140 adult and 1162 pediatric HS patients and controls identified using data from electronic health records. Primary outcome was prevalent depression. RESULTS Prevalence of depression among adults with HS was 30.0% (95% Confidence interval [CI], 29.6-30.5), compared with 16.9% (95% CI, 16.7-17.1) among controls. Among children and adolescents with HS, prevalence of depression was 11.7% (95% CI, 10.0-13.7), compared with 4.1% (95% CI, 3.6-4.7) among controls. In adjusted analyses, adults and children/adolescents with HS had 1.26 (95% CI, 1.25-1.28; P < .001) and 1.42 (95% CI, 0.999-2.01; P = .051) times the odds of having depression relative to controls, respectively. LIMITATIONS We could not evaluate the influence of disease severity on the outcome. CONCLUSION Depression is prevalent among children, adolescents, and adults with HS. Periodic screening for depression may be warranted.
Collapse
Affiliation(s)
- Shari Wright
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
| |
Collapse
|
6
|
Jalenques I, Ciortianu L, Pereira B, D'Incan M, Lauron S, Rondepierre F. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis. J Am Acad Dermatol 2020; 83:542-553. [DOI: 10.1016/j.jaad.2020.03.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
|
7
|
Zouboulis CC, Nogueira da Costa A, Makrantonaki E, Hou XX, Almansouri D, Dudley JT, Edwards H, Readhead B, Balthasar O, Jemec GBE, Bonitsis NG, Nikolakis G, Trebing D, Zouboulis KC, Hossini AM. Alterations in innate immunity and epithelial cell differentiation are the molecular pillars of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34:846-861. [PMID: 31838778 DOI: 10.1111/jdv.16147] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The large unmet need of hidradenitis suppurativa/acne inversa (HS) therapy requires the elucidation of disease-driving mechanisms and tissue targeting. OBJECTIVE Robust characterization of the underlying HS mechanisms and detection of the involved skin compartments. METHODS Hidradenitis suppurativa/acne inversa molecular taxonomy and key signalling pathways were studied by whole transcriptome profiling. Dysregulated genes were detected by comparing lesional and non-lesional skin obtained from female HS patients and matched healthy controls using the Agilent array platform. The differential gene expression was confirmed by quantitative real-time PCR and targeted protein characterization via immunohistochemistry in another set of female patients. HS-involved skin compartments were also recognized by immunohistochemistry. RESULTS Alterations to key regulatory pathways involving glucocorticoid receptor, atherosclerosis, HIF1α and IL17A signalling as well as inhibition of matrix metalloproteases were detected. From a functional standpoint, cellular assembly, maintenance and movement, haematological system development and function, immune cell trafficking and antimicrobial response were key processes probably being affected in HS. Sixteen genes were found to characterize HS from a molecular standpoint (DEFB4, MMP1, GJB2, PI3, KRT16, MMP9, SERPINB4, SERPINB3, SPRR3, S100A8, S100A9, S100A12, S100A7A (15), KRT6A, TCN1, TMPRSS11D). Among the proteins strongly expressed in HS, calgranulin-A, calgranulin-B and serpin-B4 were detected in the hair root sheath, koebnerisin and connexin-32 in stratum granulosum, transcobalamin-1 in stratum spinosum/hair root sheath, small prolin-rich protein-3 in apocrine sweat gland ducts/sebaceous glands-ducts and matrix metallopeptidase-9 in resident monocytes. CONCLUSION Our findings highlight a panel of immune-related drivers in HS, which influence innate immunity and cell differentiation in follicular and epidermal keratinocytes as well as skin glands.
Collapse
Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | | | - E Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - X X Hou
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - D Almansouri
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - J T Dudley
- Department of Genetics and Genomic Sciences, Institute of Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H Edwards
- Translational Medicine, UCB SA, Slough, UK
| | - B Readhead
- Department of Genetics and Genomic Sciences, Institute of Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - O Balthasar
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - G B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - N G Bonitsis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - D Trebing
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - K C Zouboulis
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - A M Hossini
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| |
Collapse
|
8
|
Kirby JS, Leiphart P. Standing up together to the shame and stigma associated with hidradenitis suppurativa. Br J Dermatol 2019; 182:267-268. [DOI: 10.1111/bjd.18707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. S. Kirby
- Penn State College of Medicine Hershey PA U.S.A
| | - P. Leiphart
- Penn State College of Medicine Hershey PA U.S.A
| |
Collapse
|