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Vol. 114. Núm. 3.
Páginas T271-T273 (marzo 2023)
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Vol. 114. Núm. 3.
Páginas T271-T273 (marzo 2023)
Case and Research Letter
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[Translated article] Biopsychosocial Complexity in Patients With Hidradenitis Suppurativa: A Pilot Study of a Psychodermatology Assessment Scale
Complejidad bio-psico-social en pacientes con hidradenitis supurativa: un estudio piloto de psico-dermatología
A. Goñi-Navarroa,
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Corresponding author.
, P. Mollá-Roiga, S. de la Fuente-Meirab, R. Campos Ródenasa
a Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Dermatología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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A. Goñi-Navarro, P. Mollá-Roig, S. de la Fuente-Meira, R. Campos Ródenas
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To the Editor,

Hidradenitis suppurativa is a chronic dermatologic disease affecting the hair follicle. It has a considerable effect on quality of life and is associated with marked biopsychosocial comorbidity.1

Psychodermatology, which aims to favor psychological evaluation and treatment for the care of patients with dermatologic conditions, has become increasingly important in Europe in recent years. Therefore, given the high prevalence of mental health issues among patients with medical and surgical conditions, the European Association of Consultation-Liaison Psychiatry and Psychosomatics created the INTERMED method,2 which has been validated in Spanish and recently redesigned in its self-administered format (IM-SA).3 The IM-SA aims to identify and classify biopsychosocially complex patients, enable rapid multidimensional evaluation, and improve the efficiency of the approach to patients requiring more complex medical care and, therefore, greater use of economic resources.

In order to evaluate the usefulness of the IM-SA in patients with hidradenitis suppurativa, we performed a cross-sectional pilot study of a sample of patients (n=23), all of whom were adults and in full possession of their mental faculties. The patients consecutively attended a specialist hidradenitis suppurativa clinic in the Dermatology Department of Hospital Clínico Universitario Lozano Blesa in Zaragoza, Spain between the months of March and May 2021. The study was approved by the Research Ethics Committee of the Autonomous Community of Aragon (CEICA). We collected a series of variables, namely, patients’ socioeconomic data, severity of hidradenitis suppurativa (Hurley scale), and score on the Spanish version of the IM-SA, which classifies patients into 4 domains (biological, psychological, social, and health care).

Data were processed using Jamovi 1.8.2. We obtained descriptive and analytical measures for contrast tests. Nonparametric tests were used for the latter, since the sample size was small (n=23). Statistical significance was set at P<.05.

Women scored higher overall on the IM-SA than men (16.2 [8.8] vs. 11.3 [6.5]), although the differences were not significant (P=.14). The analysis by domains yielded statistically significant differences in the psychological domain (history, current state, and prognosis), where women scored higher than men (Table 1).

Table 1.

Score in the Psychological Domain of the INTERMED Self-Assessment Questionnaire by Sex.

IM-SA domain  Sex  Score  P 
Psychological historyMale  1.3 (1.5)  .005 
Female  3.5 (1.7)   
Current psychological statusMale  0.4 (0.8)  .005 
Female  1.7 (1.2)   
Psychological prognosisMale  .048 
Female  0.4 (0.7)   

The IM-SA made it possible to classify patients according to their biopsychosocial complexity as noncomplex if they scored <19 points (n=19) or as complex if they scored ≥19 points (n=4). Analysis of the overall IM-SA score showed that this was higher in complex patients than in noncomplex patients (28 [4.7] vs. 10.6 [4.1]; P=.002). The differences in the mean scores in the different domains are shown in Table 2. The results of the study show that only 17.3% of the patients were complex. The mean (SD) IM-SA score of the 19 noncomplex patients was 10.6 (4.1), whereas that of the 4 complex patients was 28 (4.7), indicating that patients with hidradenitis suppurativa are more complex that those with other entities previously addressed using the INTERMED instrument, such as multiple sclerosis (mean score, 14), rheumatoid arthritis (mean score, 17.2), and liver transplant (mean score, 20).4

Table 2.

Score for the Domains of the INTERMED Self-Assessment (IM-SA) Questionnaire by Patient Complexity.

IM-SA domainComplexity  Score  P 
HistoryBiological statusNoncomplex  2.1 (1.4)  .125 
Complex  3.5 (1.7)   
Psychological statusNoncomplex  1.8 (1.5)  .005 
Complex  5 (0.8)   
Social statusNoncomplex  1.3 (1.3)  .010 
Complex  3.8 (1.3)   
Health careNoncomplex  0.4 (0.9)  .011 
Complex  1.5 (0.6)   
Current statusBiological statusNoncomplex  2.5 (1.6)  .039 
Complex  4.5 (1.3)   
Psychological statusNoncomplex  0.8 (1.2)  .048 
Complex  2 (0.8)   
Social statusNoncomplex  0.2 (0.4)  .009 
Complex  2.8 (2.5)   
Health careNoncomplex  1.2 (0.5)  .143 
Complex  1.8 (1.0)   
PrognosisBiological statusNoncomplex  1.2 (0.4)  .445 
Psychological statusNoncomplex  0.1 (0.3)  .406 
Complex  0.5 (1)   
Social statusNoncomplex  .002 
Complex  1.5 (1.7)   
Health careNoncomplex  0.1 (0.2)  .015 
Complex  1.3 (1.5)   

As expected, some higher IM-SA scores were associated with higher scores in the psychological and social domains (P=.005), namely, psychological history, social history, current biological status, current social status, and social and health care prognosis. This association is in line with available data, such as the findings reported by Kouris et al.,5 who found that patients with hidradenitis suppurativa experience statistically significantly more anxiety than the control group (6.4 [3.3] vs. 5.0 [1.6]; P<.001).

Our pilot study showed that the IM-SA instrument can detect and highlight complex patients, thus indicating that patients with hidradenitis suppurativa are more complex than other patient populations previously assessed using IM-SA. Since this is a pilot study, it would be interesting to extend our research in order to improve quality of care and enable care to be provided on an individual basis.


The authors declare that no funding was received for the present study.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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