<scp>WHO</scp> ‐5 Well‐Being Index Reveal the Burden of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease characterized by recurrent nodules, abscesses, sinus tracts, and scarring in intertriginous areas. Beyond its painful lesions, HS is among the dermatologic diseases with the highest psychosocial burden [1-3]. The World Health Organization (WHO)-5 Well-Being Index is a brief, validated five-item questionnaire assessing subjective well-being within the previous 2 weeks. Scores range from 0 to 100, with values < 50 indicating possible depression requiring further assessment. Limited data are available for patients with HS [4]. We evaluated WHO-5 scores in 132 patients with active HS (63.6% men, 36.4% women; mean age 40.3 years) regardless of current therapy. All three Hurley stages were represented: 22.0% stage I, 12.1% stage II, and 65.9% stage III. The mean WHO-5 score was 51.4 ± 29.0 (standard deviation, SD), median 52.0. No significant difference was observed between females and males (51.8 vs. 51.1) or across Hurley stages. Patients with Hurley I had a mean WHO-5 score of 52.7 ± 27.2, Hurley II 45.8 ± 31.3, and Hurley III 52.0 ± 29.4 (p = 0.717) (Table 1). WHO-5 scores < 50 were identified in 47.6% of male patients and 47.9% of females (Figure 1). Overall, 47.7% of patients screened positive for possible depressive symptoms. A recent study reported that HS patients had the lowest WHO-5 scores among common inflammatory dermatoses, with nearly half scoring < 50 [4]. Pender et al. analyzed WHO-5 in patients with HS, atopic dermatitis, and psoriasis and found a mean WHO-5 of 48.1 in HS. The main differences between their cohort and ours were gender distribution (63.6% males in our study vs. 12.3% in theirs) and sample size (132 vs. 73 patients). We also examined WHO-5 across Hurley stages, which their study did not report. Interestingly, WHO-5 scores did not differ significantly by disease stage. Even patients with milder disease exhibited substantial psychological impairment, underscoring that physical severity alone does not reflect the overall disease burden. Similarly, the absence of sex differences suggests that HS is not primarily a cosmetic concern but rather a disease affecting quality of life. In our study, we found a high SD of WHO-5 scores (29 points), which demonstrates marked heterogeneity in well-being among HS patients. While some reported near-normal values, others demonstrated extremely low scores. In the study by Pender et al., standard deviations also varied between diseases—19.4 for HS, 24.9 for psoriasis, and 23.4 for atopic dermatitis—supporting the concept that psychological burden differs not only in magnitude but also in distribution across inflammatory dermatoses. Routine WHO-5 screening in HS care may offer several advantages: it is fast, easily administered during clinic visits, and provides a standardized measure of well-being that complements clinical severity scales for HS. It enables early identification of patients at risk for depression who may benefit from mental-health referral. Integrating WHO-5 into routine HS management could help bridge the gap between dermatologic and psychological care. Addressing mental health proactively may improve treatment adherence, enhance overall quality of life, and potentially reduce inflammatory activity, as depression itself can exacerbate systemic inflammation [5]. Nearly half of the HS patients in our cohort screened positive for depressive symptoms (score < 50) using the WHO-5 Index, consistent with observations from previous studies in HS [4]. Implementing the WHO-5 assessment in daily dermatologic practice may help normalize discussion of mental health, promote holistic care, and ultimately improve outcomes for this highly burdened patient population. The WHO-5 has not been broadly used in HS, so larger studies are needed to determine whether WHO-5 scores improve in parallel with clinical indices during biologic or surgical treatment, providing an additional endpoint for evaluating therapeutic success. This work was supported by the Charles University research Cooperatio 34, Internal Disciplines. All participants provided informed consent. The study was conducted in accordance with institutional and national ethical standards. Patient-level data used for this analysis were de-identified, and Institutional Review Board approval was not required for this study. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.