Internalized Skin Bias and Health Related Quality of Life in Hidradenitis Suppurativa

The associations of hidradenitis suppurativa and internalized skin bias and a possible association between adverse psychopathological outcomes and impaired HRQOL is investigated.

In patients with hidradenitis suppurativa (HS), the social stigma associated with their disease can lead to mental health issues and poor health related quality of life (HRQOL), according to study results published in the Journal of the American Medical Association Dermatology. Associations of depression and anxiety with HRQOL may be the result of this internalized skin bias, the investigators posited.

Frequently, patients with HS emote high levels of internalized skin bias (ISB), morphing the physical disease into a comorbid mental disorder which may significantly exacerbate an already downgraded HRQOL. Researchers sought to evaluate the associations of HS and ISB and to “determine if ISB may mediate the associations between adverse psychopathological outcomes and impaired HRQOL.”

To accomplish this, they conducted a cross-sectional study of 230 adult patients (median age 39.2±11.2; 90.9% women; 77.7% White; 88.7% non-Hispanic) with HS recruited from virtual social networks and 1 medical center from April to July, 2021. Patients provided demographic and disease history and completed the Internalized Skin Bias Questionnaire (ISBQ), Burns Anxiety Inventory, the Beck Depression Inventory−II, and the Hidradenitis Suppurativa Quality of Life (HiSQOL) instrument. The primary outcome was their health-related quality of life measured by the HiSQOL.

Among these patients, 56.5% demonstrated moderate or greater anxiety and 45.7% moderate or greater depression. HRQOL scores (34.5±16.7) indicated significant levels of impairment; ISBQ scores showed a moderate correlation with depression (r = 0.67) and fair correlations with HRQOL (r = 0.52) and anxiety (r = 0.56). Researchers said, “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.”

Study limitations included the small sample size, predominance of White female participants, selection bias, misclassification of disease severity, and weak correlations with ISBQ scores.

Researchers concluded 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.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Butt M, Rigby A, Leslie DL, et al. 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. Published online March 16, 2022. doi:10.1001/jamadermatol.2022.0248