Association of treatment burden with quality of life and distress in hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with substantial impairment in quality of life and psychological well-being. The impact of cumulative treatment exposure and its relationship with multidimensional disease burden in HS has not been sufficiently discussed. The aim of this study is to investigate the associations between cumulative treatment burden, quality of life impairment, psychological symptom burden, disease activity, and patient-perceived severity in patients with HS.Methods This multicenter cross-sectional study included previously treated adult HS patients. Participants completed validated Turkish versions of the Dermatology Life Quality Index (DLQI), Symptom Checklist-90-Revised (SCL-90-R), and the Hidradenitis Suppurativa Self-Assessment Tool (HSSA). A Treatment Burden Index (TBI) was developed to quantify cumulative therapeutic exposure based on guideline-weighted treatment modalities.Results Ninety-three patients were included (mean age 34.5 +/- 11.0 years; 57% male). Higher TBI was moderately correlated with greater QoL impairment (Spearman rho = 0.401, p < 0.001) and flare frequency. TBI was weakly correlated with psychological symptom burden. DLQI scores were positively associated with flare frequency and SCL-90-R scores, whereas the SCL-90-R scores were not associated with flare frequency or patient-perceived disease severity.Conclusions HS burden is multidimensional, with partially independent domains of disease activity, treatment burden, quality of life impairment, and psychological distress. Cumulative treatment exposure is closely linked to QoL impairment and disease activity but only weakly associated with psychological symptom burden. Identification of distinct burden phenotypes may facilitate more personalized and patient-centered management strategies in HS.