The impact of negative emotions on quality of life for patients with hidradenitis suppurativa
Today’s report also covers research into pregnancy and nail changes, comorbid autoimmune conditions in women with autoimmune bullous diseases, and more (1,320 words, 6 minutes)
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Good morning and welcome to this edition of the Women in Dermatology e-newsletter from Chronicle Companies. We’re pleased to have you join us. This biweekly bulletin will update you on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them. We welcome your feedback and opinions, so let us know if you have any comments, observations or suggestions. You can email them to us at health@chronicle.org.
A study published in the International Journal of Women’s Dermatology (Oct. 2022; 8(3):p e046) explored the social, emotional, and medical experiences of patients with hidradenitis suppurativa (HS) to understand the connection between negative emotions and experiences and quality of life.
HS disproportionally affects women and is characterized by painful, deep, and swollen lesions, primarily in the groin, genital, and armpit areas. The pain and discomfort produced by the lesions can affect a patient’s quality of life. While many intersecting factors are believed to influence HS, the specific cause of the disease has not been identified. Similarly, various therapeutic options exist for HS, but none are known to be effective for all or even most patients. The lack of a standard treatment can lead to delays in finding symptom relief which can ultimately affect a patient’s mental health and cause an even greater impact on their quality of life.
According to the study’s authors, HS patients often report emotional distress due to body dissatisfaction which can lead to depression and anxiety. They add that HS patients are at a higher suicide risk because of poor mental health and the stigma surrounding skin disorders. Negative thoughts and beliefs regarding the disease are also linked to an increased risk of developing depression and anxiety as comorbidities. HS patients often avoid social, occupational, and other activities as a way of coping with the symptoms and stigma associated with the condition, which can cause a decline in health-related quality of life and a rise in depressive symptoms. The study notes that research on patient experiences shows that mental health outcomes are influenced by patient communication with healthcare providers and romantic partners.
For this study, the authors recruited participants through HS online support groups, social media, and an Instagram account created for the study. A total of 263 patients completed the survey, including 249 women. The researchers used the Hidradenitis Suppurativa Quality of Life tool (HiSQOL) to measure the impact of HS on participants’ daily life, physical discomfort, emotional well-being, and sexual functioning. The participants were also asked about previous negative experiences with healthcare providers.
The authors found more than 66% of participants stated they had been at least moderately depressed and/or anxious over the previous seven days because of their HS. Furthermore, more than 43% of participants reported feeling very or extremely depressed and/or anxious because of their HS. Additionally, non-White participants reported a greater negative impact of HS on their lives than White participants
Most patients experienced delays before receiving an accurate diagnosis, which tarnished their experience with healthcare providers. More than half of the participants received a misdiagnosis before being accurately diagnosed with HS. Close to 76% of participants also reported experiencing some sort of negative emotion when communicating with healthcare providers about their HS. Participants who reported negative experiences with healthcare providers tended to have lower quality-of-life scores.
Finally, most participants reported that HS had a negative effect on their physical relationship with their romantic partner. In contrast, only 26.9% stated that HS had a negative impact on their emotional connection with their partner, with most participants reporting either a neutral (56.2%) or a positive (16.9%) impact.
Bottom line
HS can significantly affect a patient’s quality of life. Future treatments should prioritize mental health to better serve patients. Patients’ experiences with healthcare providers can also affect their quality of life, and it is essential for physicians to provide optimal care. Finally, a multidisciplinary approach is recommended for the treatment of HS.
Real-world effectiveness and safety of collagenase clostridium histolyticum-aaes injections for the treatment of thigh cellulite in women
An article published in the Journal of Cosmetic Dermatology evaluated the safety and efficacy of collagenase clostridium histolyticum-aaes (CCH-aaes) in treating thigh cellulite in female patients. The authors found that CCH-aaes is an effective treatment for mild-to-moderate thigh cellulite that also helps reduce cellulite-related discomfort.
For this article, the researchers analyzed data from the phase 3, open-label REAL study that included 22 women with mild-to-moderate cellulite on both thighs. Participants received ≤0.84 mg of subcutaneous CCH-aaes, on up to 12 dimples per thigh, in three treatment sessions. Investigators and patients reported improvements at the 90-day follow-up.
Research published in Skin Appendage Disorders described the prevalence and types of nail changes in pregnant women. The authors found that nail changes are common during pregnancy, but only ingrown and whitened nails are significantly more common in pregnant women than in nonpregnant women.
The researchers administered a 32-question survey to 73 pregnant and 94 nonpregnant patients at the Weill Cornell Obstetrics and Gynecology waiting room. Nail changes were reported by 34.2% of pregnant women and 12.8% of nonpregnant women. Most patients did not report changes in nail growth, thickness, or brittleness during their pregnancies.
Investigation of comorbid autoimmune diseases in women with autoimmune bullous diseases
A review published in the International Journal of Women’s Dermatology analyzed the associations of autoimmune bullous diseases (AIBDs) with other autoimmune diseases in female patients. The researchers found that AIBDs are often associated with other severe autoimmune diseases, including pemphigoid, psoriasis, autoimmune thyroid disease, inflammatory bowel disease (IBD), and Crohn’s disease.
The authors also found that autoimmune diseases in general are significantly more prevalent in female patients. They add that this prevalence may be linked to the X-chromosome.
Spanish translation, transcultural adaptation, and validation of the Quality of Life Questionnaire in female pattern hair loss
The authors of a study published in Skin Appendage Disorders translated and adapted the Women’s Androgenetic Alopecia Quality of Life (WAA-QoL) questionnaire into Spanish and validated their new version. The researchers found their Spanish translation of the WAA-QoL questionnaire is a consistent and valid tool for the assessment of female pattern hair loss in Spanish-speaking communities.
According to the authors, the WAA-QoL is the only specific tool to evaluate QoL in female pattern hair loss patients. It had not been officially adapted or validated in Spanish before. For this study, the authors submitted and applied their translated version of the WAA-QoL to 453 women from various Spanish-speaking countries.
Dr. Chalukya Gunasekara, a Sri Lanka-based dermatologist, discusses the main causes of hair loss in women as well as possible treatments and how to prevent it.
Multiple annular plaques on the thighs of an eight-year-old girl
A case study published in the International Journal of Dermatology reported on an eight-year-old girl who presented with asymptomatic red, swollen, scaly lumps on her lower limbs. The patient said that the lesions appeared during the winter. After a histological examination, the patient was diagnosed with cold-associated perniosis of the thighs.
The patient’s lesions evolved into subtly pigmented spots, which disappeared after one month. According to the authors, this condition is very common in young women and girls. In the 1980s, it was believed to be exclusively associated with horse riding but now is associated with tight-fitting clothes and outdoor activities such as hiking or cycling.
“Having a passion for what you do is almost essential. It makes working towards a goal exciting and rewarding. I don’t think I would ever be this successful in my career if I didn’t have the authentic genuine passion I do. Studying to be a dermatologist, which is the most competitive specialty in medical school, means four–six years of studying the skin after four years of medical school. Without a genuine interest in that area of medicine, it would most likely be torture and near impossible.”
— Dr. Stefani Kappel, a California-based dermatologist, in an interview with Authority Magazine.
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