CLINICAL REPORT
757 ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Influence of Itch and Pain on Sleep Quality in Patients with Hidradenitis Suppurativa
Karolina KAAZ, Jacek C. SZEPIETOWSKI and Łukasz MATUSIAK Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
There is a lack of data evaluating the influence of hidradenitis suppurativa-related subjective symptoms on sleep quality. The aim of this study was to assess the influence of itch and pain on sleep quality in 108 patients with hidradenitis suppurativa compared with 50 controls. The Athens Insomnia Scale( AIS) and Pittsburgh Sleep Quality Index( PSQI) were used to evaluate a spectrum of sleep disturbances. Mean ± standard deviation AIS and PSQI scores among patients with hidradenitis suppurativa vs. controls were assessed as 5.4 ± 4.3 vs. 5.5 ± 3.4 and 6.5 ± 3.6 vs. 3.1 ± 1.9 points, respectively. The presence of both itch and pain had a significant impact on the frequency of insomnia. Pain was a crucial factor responsible for poor sleep quality among patients with hidradenitis suppurativa; its presence significantly affected subjective sleep quality, sleep duration and daytime dysfunction. Itch and pain have an important impact on insomnia and sleep quality in patients with hidradenitis suppurativa.
Key words: hidradenitis suppurativa; PSQI; itch; pain; quality of life; sleep; AIS; acne inversa; VAS.
Accepted May 9, 2018; Epub ahead of print May 14, 2018 Acta Derm Venereol 2018; 98: 757 – 761.
Corr: Jacek C. Szepietowski, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, PL-50-368 Wrocław, Poland. E-mail: jacek. szepietowski @ umed. wroc. pl
Hidradenitis suppurativa( HS) is a chronic, inflammatory, recurrent, debilitating and suppurative disease of the hair follicle, manifested by painful abscesses, fistulas and scarring lesions in the apocrine glandbearing areas of the body, generally the axillae, inguinal and anogenital regions( 1). The mean prevalence of HS in the Caucasian population is estimated as 1 %, with a predominance in females( 2, 3). HS-related quality of life( QoL) impairment includes an impact on multiple domains of psychophysical functioning among affected patients, resulting in depression, anxiety, stigmatization, fatigue and decreased overall activity( 4, 5).
Sleep is a physiological, fundamental, active process that engages approximately one-third of our lives. Sleep is regulated by 2 major processes; the circadian system and homeostatic sleep drive( 6). As the skin condition plays an important role in proper sleep activity, including core body temperature control, thermoregulation, sleep onset, and awakenings during sleep, it is possible that sleep quality could be disturbed in chronic inflammatory
SIGNIFICANCE
• Hidradenitis suppurativa is a chronic, inflammatory, recurrent, debilitating and suppurative disease of the hair follicle manifested by painful abscesses, fistulas and scarring lesions in intertriginous areas. As the skin condition plays an important role in proper sleep activity, it could be suspected that sleep quality could be disturbed in such chronic inflammatory skin disease. Moreover, the hidradenitis suppurativa related symptoms such as pain, itch, unpleasant smell accompanying hidradenitis suppurativa may additionally intensify sleep disturbances.
• This study revealed that the presence of both itch and pain had a significant impact on insomnia frequency. The pain was a crucial factor responsible for poor sleep quality among hidradenitis suppurativa sufferers; its presence affected significantly subjective sleep quality, sleep duration and daytime dysfunction.
dermatoses, including HS. The symptoms that accompany HS, such as pain, itch, and unpleasant smell, may also intensify sleep disturbance( 7). Furthermore, sleep abnormalities in such chronic disorders could result, in turn, in significant impairment of QoL.
There is a lack of data evaluating the influence of itch and pain on sleep quality in patients with HS. The aim of the current study was to evaluate this issue.
MATERIALS AND METHODS
The study was conducted on 108 Caucasian patients with HS( 51 females and 57 males) with the mean ± standard deviation( SD) age of 15 – 67 years( 36.3 ± 12.1) years and 50 sex- and age-matched healthy controls( 25 females and 25 males)( Table I). Participants were recruited from cohort of patients admitted to the Department of Dermatology, Venereology and Allergology of Wroclaw Medical University, Poland. The diagnosis of HS was established according to well-defined clinical criteria in agreement with the Dessau definition( 1). The mean ± SD duration of disease was assessed as 9.1 ± 8.3 years( range 1 month to 46 years). Disease severity was evaluated with Hidradenitis Suppurativa Score( HSS), Hidradenitis Suppurativa Severity Index( HSSI) and Hurley’ s staging( 8 – 10).
The majority of patients with HS were overweight and the majority of controls were in the normal weight range, with mean ± SD body mass index( BMI) 28.8 ± 5.4 and 24.7 ± 3.6 kg / m 2, respectively. Moreover, the groups studied consisted of 72.2 %( HS patients) vs. 32 %( controls) of current or ex-smokers.
All patients and controls with an itchy / painful skin condition of any type, or who were receiving any anti-pruritics or pain-killers( e. g. antihistamines, immunomodulators / immunosuppressants, etc.(> 5 half-lives washout period)), were excluded. None of the
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2967 Acta Derm Venereol 2018; 98: 757 – 761