The Association Between Hidradenitis Suppurativa and Suicidal Ideation, Attempts, and Completion: A Systematic Review

Abstract

Background: Hidradenitis suppurativa (HS) is a painful, chronic, inflammatory skin condition that can impact the quality of life. The potential link between HS and an increased risk of suicidal ideation, attempts, and completion has been inconsistently described in the past. Objectives: This systematic review aims to explore the potential association between HS and suicide. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a comprehensive search was performed by two independent reviewers on MEDLINE, PubMed, and Embase from the conception of the database to April 5th for case reports, case series, clinical trials, cohort studies, and observational studies involving the relationship between HS and suicide. Search terms included “Hidradenitis suppurativa,” “acne inversa,” “suicide,” “suicidality,” “suicidal ideation,” “suicide attempt,” and “completed suicide.” Results: Out of 106 articles reviewed, nine studies met the inclusion criteria, including a case report, 7 cohort studies, and a prospective multinational survey. The studies suggest that patients with severe, treatment-resistant HS have an increased risk of suicide. While some studies suggest that biological treatment might decrease the risk of suicide, others indicate a possible increase in risk among females with HS and patients needing biologicals. Limitations: The systematic review is limited by the small sample size of studies and the lack of randomized controlled trials. Conclusions: Screening for depression and suicidal death should be a crucial part of the care provided to patients with HS due to the potential increased risk of suicide.