Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(4):e2024276 1 Work Impairment in Hidradenitis Suppurativa Compared to Psoriasis: A Cross-Sectional Study Aikaterini Tsentemeidou1, Efstratios Vakirlis1, Dimitra Kiritsi1,2, Aimilios Lallas1, Michael Arabatzis1, Elena Sotiriou1 1 First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece 2 Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany Key words: Bimekizumab, Psoriasis treatment, Biological therapy, TNF-α, Hallopeau Citation: Tsentemeidou A, Vakirlis E, Kiritsi D, Lallas A, Arabatzis M, Sotiriou E. Work Impairment in Hidradenitis Suppurativa Compared to Psoriasis: A Cross-Sectional Study. Dermatol Pract Concept. 2024;14(4):e2024276. DOI: https://doi.org/10.5826/dpc.1404a276 Accepted: July 18, 2024; Published: October 2024 Copyright: ©2024 Tsentemeidou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Aikaterini Tsentemeidou, First Department of Dermatology and Venereology, School of Medicine, Aristotle University, 124 Delfon St, 54643, Thessaloniki, Greece. Phone: +302313308822. E-mail: ktsenteme@gmail.com Introduction Several studies have reported that hidradenitis suppurativa (HS) greatly impacts work life, finances, and career pros- pects [1]. Apparently, the majority of HS patients have taken sick leave because of their skin condition at least once, with a mean of three such cases of absence from work, or approx- imately 34 days, per year [2]. Psoriasis, a similarly chronic and burdensome inflammatory skin disease, also seems to affect work and productivity [3]. A direct comparison of the impact on work between HS and psoriasis, however, has not yet been performed in a real-life setting. Case Presentation We used the Work Productivity and Activity Impairment Questionnaire (WPAI, Table S1) in 203 HS patients (mean age 39.7 years, [38.03, 41.38], 51.7% women) and 203 pso- riasis patients (mean age 48.96 years, [46.68, 51.23], 42.9% women), prospectively sourced from a tertiary dermatology hospital from March 2021 until September 2023. We found that significantly more HS patients were unemployed (41.4% vs 28.1%, P=0.005), despite being younger on average. A quarter of HS patients (26.1%) and only 3.4% of psoriasis patients had been absent from work because of their disease over the previous week, with 53.2% and 10.8% of those HS and psoriasis patients remaining at work (respectively) reporting low productivity as a result of their symptoms. Last, 53.2% of HS patients and 8.4% of psoriasis patients reported difficulty performing daily activities over the previ- ous week. The percentages of total work impairment, absen- teeism, presenteeism, and daily activity impairment (mean values) are presented in Table 1. Conclusion The results of our study align with previously pub- lished data. According to three studies (The Netherlands, 2 Research Letter | Dermatol Pract Concept. 2024;14(4):e2024276 Denmark, Canada) that calculated WPAI score in a cohort of HS patients, 62%, 57%, and 78% of them, respectively, were employed [1], [4], [5]. The percentages of those hav- ing taken sick leave over the previous week were 26%, 6%, and 23.53%, respectively, with mean absenteeism reported as 0% (median, range 0-5.3%), 7%, and 14.5%, respec- tively [1], [4], [5]. Mean presenteeism was 20% (median, range 0-50%), 21.3%, and 30.1%, respectively [1], [4], [5]. Factors associated with greater work impairment were se- vere disease, inguinal/gluteal location, depression, anxiety, and worse quality of life [4]. A study that used data from clinical trials to compare HS and psoriasis-induced burden concluded that total work and productivity impairment in HS was double that in psoria- sis (35.4% vs 18.2%) [6]. A multinational study investigat- ing work impairment in psoriasis patients found that total impairment, absenteeism, and presenteeism were approxi- mately 19%, 2.5%, and 16.5%, respectively [3]. The afore- mentioned percentages are higher than those in our study, possibly because Greek patients have easy access to derma- tology, while prescription of biologics for psoriasis is quite simple (no case-by-case petition/approval is warranted), meaning that truly severe psoriasis is becoming rarer. HS and psoriasis share keen similarities in their be- havior and ability to cause systemic, debilitating disease. Unlike psoriasis, which often has a more predictable course and can be managed with established treatments, HS pa- tients frequently face unpredictable disease progression and inadequate treatment options. This could explain the noted disparity between them regarding work impairment. Our findings also underscore the need for targeted interventions to support individuals with HS in the workplace. References 1. Yao Y, Jørgensen AR, Thomsen SF. Work productivity and ac- tivity impairment in patients with hidradenitis suppurativa: a cross-sectional study.  Int J Dermatol. 2020;59(3):333-340. DOI:10.1111/ijd.14706. 2. Matusiak Ł, Bieniek A, Szepietowski JC. Hidradenitis suppura- tiva markedly decreases quality of life and professional activity.  J Am Acad Dermatol. 2010;62(4):706-708.e1. DOI:10.1016 /j.jaad.2009.09.021 3. Villacorta R, Teeple A, Lee S, Fakharzadeh S, Lucas J, McElligott S. A multinational assessment of work-related produc- tivity loss and indirect costs from a survey of patients with psoria- sis. Br J Dermatol. 2020;183(3):548-558. DOI:10.1111/bjd.18798. 4. van Straalen KR, Prens LM, Hylkema TH, et al. Impact of hidra- denitis suppurativa on work productivity and associated risk fac- tors. J Am Acad Dermatol. 2021;84(5):1401-1405. DOI:10.1016 /j.jaad.2020.07.115. 5. Sandhu VK, Shah M, Piguet V, Alavi A. The impact of hidrade- nitis suppurativa on work productivity and activity impairment.  Br J Dermatol. 2020;182(5):1288-1290. DOI:10.1111/bjd.18695. 6. Hamzavi IH, Sundaram M, Nicholson C, et al. Uncovering bur- den disparity: A comparative analysis of the impact of moderate- to-severe psoriasis and hidradenitis suppurativa. J Am Acad Dermatol. 2017;77(6):1038-1046. DOI:10.1016/j.jaad.2017 .07.027. Table 1. Comparison of Disease Impact on Work and Daily Activities in Hidradenitis Suppurativa and Psoriasis Patients, based on the Work Productivity and Activity Impairment Questionnaire. HS Patientsa Psoriasis Patients Differenceb Women 105 (51.7%) 87 (42.9%) P=0.074 Age 39.7 [38.03, 41.38] 48.96 [46.68, 51.23] P<0.001 IHS4c 4,86 [4.13, 5.59] n/a - Hurley stage I 31 (15.3%) n/a - Hurley stage II 121 (59.6%) n/a - Hurley stage III 51 (25.1%) n/a - DLQId 8.14 [6.79, 9.49] 6.87 [5.92, 8.12] P=0.04 PASIe n/a 8.21 [7.24, 9.33] - Total work impairment 31.12% [26.14%, 36.10%] 4.95% [2.46%, 7.44%] P<0.001 Absenteeismf 10.14% [7.3%, 12.98%] 2.22% [0.64%, 3.79%] P<0.001 Presenteeismg 28.72% [24.1%, 33.34%] 4.43% [2.23%, 6.63%] P<0.001 Daily activities impairment 27.29% [22.87%, 31.71%] 3.9% [1.77%, 6.02%] P<0.001 aHidradenitis suppurativa. bDifference is significant if p<005.cHidradenitis Suppurativa Severity Score System. dDermatology Life Quality Index. ePsoriasis Area Severity Index. fAbsence from work. gReduced productivity at work.