The Prevalence and Severity of Pain in Hidradenitis Suppurativa

pain underarm armpit woman female doctor
Breast Cancer Prevention Concept. A woman suffers from pain in the armpit. Sweating, unpleasant odor, redness, tooth and inflammation in the armpit.
The prevalence and characteristics of hidradenitits suppurative-related pain in patients was assessed in a large study.

Patient experiences with hidradenitis suppurativa (HS)-related pain were outlined in study data published in Acta Dermato-Venereologica. In a cross-sectional survey of patients with HS, pain was highly prevalent and correlated with disease severity. Women and current smokers tended to experience more intense pain.

Investigators administered a cross-sectional survey to patients with HS who received care at participating dermatology clinics in Germany from April 2017 to February 2020. Demographic and clinical characteristics were extracted from medical records. HS severity was measured using the Hurley staging system and the International Hidradenitis Suppurativa Severity Score System (IHS4). The primary outcome was HS-related pain, assessed with a Numerical Rating Scale (NRS). During the survey, patients were asked to rate the most intense pain that occurred in the last 24 hours on a scale from 0 to 10. Pain levels were categorized as mild (NRS 6 points or fewer), moderate (6 or greater and 8 points or fewer), and severe (greater than 8 points). Descriptive statistics were used to characterize pain in patients with HS.

A total of 1795 patients with HS were included in the study, among whom 1152 were women. Mean age was 40.0 ± 11.8 years. The majority of patients were active smokers (55.6%); a further 10.5% were classified as heavy smokers. The distribution of patients by Hurley stage was as follows: 23.7% stage I; 59.1% stage II; 17.2% stage III. Per IHS4 scores, 28.4% of patients were classified as having mild HS; 35.0% as moderate HS; and 36.6% as severe HS.

Overall, 1500 patients (83.6%) reported some degree of pain in the last 24 hours. Mean NRS score for the total cohort was 3.9 ± 2.9 points out of a possible 10, indicating mild to moderate pain. Pain was classified as mild in 77.6% of patients, moderate in 15.9%, and severe in 6.5%. Mean pain intensity was greater among women compared to men (4.1 ± 2.9 vs 3.5 ± 2.8 points; P <.001). Pain intensity was also greater among smokers compared to non-smokers (4.0 ± 2.9 vs 3.7 ± 2.8; P <.02). A significant correlation was observed between HS severity and pain intensity. The most severe pain was observed in the Hurley stage III group (4.9 ± 2.9 points), followed by stages II (3.9 ± 2.9 points) and I (2.9 ± 2.7) (P <.001 for trend). Similarly, pain intensity was strongly correlated with IHS4 severity scores (P <.001). Pain was also associated with the number of affected areas; patients with multiple HS lesions reported greater pain than patients with a single localization (P <.001).

Disease-related pain was highly prevalent in this cohort of patients with HS. HS-related pain was further associated with poorer quality of life, as measured by the Dermatology Life Quality Index. The primary study limitation was the use of a single measurement to assess HS-related pain. The researchers noted that further research in a longer-term study may better capture pain in patients with HS.

“[Our] results clearly show that pain is an important and frequent burden for patients with HS,” investigators wrote. “During the diagnosis and treatment of HS, clinicians should pay close attention to the management of accompanying pain.”


Krajewski PK, Matusiak Ł, von Stebut E, et al. Pain in hidradenitis suppurativa: a cross-sectional study of 1,795 patients. Acta Derm Venereol. 2021;101(1):adv00364.