Syndemic and dermatology: A case study in hidradenitis suppurativa

To the Editor: With this preliminary work, we wanted to investigate the burden of hidradenitis suppurativa (HS) on patients, in the framework of the Syndemic theory.1 In other words, we want to understand if the simultaneous presence of different clinical, psycho-social, and sociodemographic factors is associated with increasing HS severity. This cross-sectional study included 599 patients with HS who completed self-report questionnaires to assess sociodemo-graphic and clinical variables (ie, disease severity, presence of psychological distress, and quality of life). A combined, cumulative effect of factors was commuted as ‘‘Syndemic scores’’ and calculated as follows: Syndemic-3 refers to the scores obtained by summing the presence of ‘‘pain,’’ ‘‘depression,’’ and ‘‘smoking’’ variables; Syndemic-4 refers to the scores obtained by summing all Syndemic-3 variables plus ‘‘diagnostic delay’’; and Syndemic-5 refers to the scores obtained by all Syndemic-4 variables plus ‘‘place of residence.’’ One point was added for each single above-cutoff factor observed. Analysis of variances were used to calculate mean levels for all variables according to the numbers of factors for each Syndemic score. Increasing levels of the ‘‘Syndemic scores’’ are consistently associated with a greater severity of HS, both in terms of disease (ie, objective clinical severity) and illness, as measured by patient-reported outcomes (Table I).