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