Centre of Evidence of Dermatology Best practice guidelines

Guidelines hidradenitis suppurativa Updated on august 2019


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The use of this data is under the sole responsibility of the user. The French Dermatology Society cannot be blamed for a misinterpretation of the data provided by the site, or in the event of erroneous information. This decision tree and all the contents of this site have been developed in the context of updated data from science according to the HAS methodology, expert opinions and reviewers of the various documents and in the context of the French healthcare system.

Psychological impact

Back to decision-making tree Print last updated on 12/02/2020

HS is a chronic disease which has a serious consequences for patients’ interpersonal relations and self body image, and which affects the senses of touch, smell and sight.

In physical terms:
pain, odour and discharge

Pain is in most cases identified by patients as the main cause of many of their difficulties. In their words, pain is the cause of irritability, anger and aggressiveness, and therefore of their isolation and reclusiveness.

This invasive pain can also create difficulties at work, make everyday positions and movements painful, and frequently causes patients to avoid physical contact with others, including close relations, in reaction. Odour is frequently cited as contributing to distancing the patient from others, which directly affects interpersonal relations: patients have the impression that they smell bad, with odours and pus discharge, which creates feelings of embarrassment, shame and fear of rejection, thus reinforcing reclusive behaviour.

In addition, pain can cause patients to refrain from sport activities, or to cease any such activity. This physical inactivity can sometimes result in weight gain, often cited by patients (and which has a negative impact on their self-esteem and body image).

Surgery is often mutilating and can have negative consequences on patients’ body image owing to the resulting traces and scars.

A feeling or powerlessness expressed by patients is often prominent in discussions with them. Outbreaks lead patients to consider their disease “uncontrollable”, creating a feeling of incomprehension vis-à-vis their own body.

In terms of interpersonal, social and emotional relations

In certain cases, this disease can result in a life lacking in social relations and friendships, and a lack of or renunciation of love life.

Patients express this remoteness from relationships by distancing themselves from their own emotions, avoiding contact with others, hiding their lesions from close relations, feeling uncomfortable in establishing a relationship, or by refusing to invest time or energy in creating or developing friendships or other social relationships.

For couples’ emotional and sexual relations, the consequences of not being able to enjoy physical contact because of pain can create difficulties (fear of being held in another’s arms, embraced tightly, of being jostled, etc.). The feeling of shame for their own body, of the physical aspect, the odours and discharge, is also frequently mentioned as provoking apprehension about sexual relations and a loss of interest in sexual relations.

All these factors contribute to withdrawal, a feeling of distance, of not being understood, with a risk of social relations being broken off.


This disease has a significant impact on patient morale.

In psychopathological terms, some patients develop a very low mood, with a risk of depression, sometimes associated with suicidal tendencies.

Chronic, long-lasting pain, loss of employment and social isolation are indicators that a risk of breakdown should be monitored.

Self-esteem can be heavily impacted and diminished; self-devaluation and the feeling of being a disappointment for close relations add to the risk of depression.

Patients may also indicate a loss of pleasure and interest in things in general.

Professional life

In terms of professional life, this disease can have very heavy consequences.

Terminating professional activities can indicate a serious risk of isolation and of deteriorating morale.

In addition, frequent absences from work caused by outbreaks or pain may provoke a feeling of failure in patients.

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