PS03 Psychiatric comorbidity in patients with hidradenitis suppurativa: a retrospective review of a tertiary centre clinic

Hidradenitis suppurativa (HS) is closely linked to psychiatric comorbidities, elevated suicide risk, stigmatization and body image impairment (Patel K, Lee, H, Rastogi S et al. Association between hidradenitis suppurativa, depression, anxiety, and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 2020; 83: 737–44). We conducted a retrospective review of the first 100 patients referred to our tertiary HS service from August 2020 to identify those receiving psychiatric input. We assessed patient characteristics, underlying mental health diagnoses, treatment, mental health and HS severity scores, and referral outcomes. Among the 100 patients, 25 were referred to a tertiary psychodermatology service and 6 were already receiving psychiatric care. Of these 31 patients, 81% were female, the average age was 34 years and the mean body mass index was 35.6 kg m−2. Overall, 60% currently smoked and 93% had Hurley scores of 2 or 3. Compared with those not referred for psychiatric input, these 31 patients exhibited higher baseline abscess and inflammatory nodule (AN) counts of > 5 (50% vs. 28%), severe pain scores > 7 out of 10 (48% vs. 21%), severe General Anxiety Disorder-7 (GAD-7) scores > 15 (44% vs. 37%), severe Patient Health Questionnaire-9 (PHQ-9) scores > 20 (40% vs. 21%) and high Dermatology Life Quality Index (DLQI) scores > 10 (81% vs. 68%). Of those referred for or already receiving psychiatric care, 94% had received a formal mental health diagnosis, with 62% having more than one diagnosis. The most common diagnosis was anxiety and depression, followed by post-traumatic stress disorder, eating disorders and emotionally unstable personality disorder. One-third reported thoughts of suicide or self-harm, with 19% of patients experiencing this on several days and 10% nearly every day. While no significant difference in systemic or biologic therapy usage was observed, treatment led to improved AN counts, and reductions in GAD-7, PHQ-9 and DLQI scores. No change was noted in severe pain scores (47% vs. 48%). Of the 25 patients referred for psychiatric input, 8 were seen, 3 did not attend and 14 await review. Overall, 55% (17 of 31) were encouraged to self-refer for psychological support, including National Health Service talking therapies, cognitive behavioural therapy and bereavement support. Identifying underlying mental health diagnoses and addressing psychological burden alongside medical treatment are essential to comprehensively manage HS. Many HS services do not have links to psychiatry, and the demand for psychological support for patients with HS exceeds available capacity. The introduction of HS-specific community interventions could enhance patients’ access to timely and effective psychological care while increasing our understanding of patients’ needs.