Impact of Bariatric Surgery on Quality of Life and Psychological Well-Being Among Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with obesity, substantial psychosocial burden, and symptom-related discomfort. Bariatric surgery achieves sustained weight loss and may improve psychological well-being, yet its effect on HS-related quality of life and symptom burden remains uncertain. Objective: To evaluate the association of bariatric surgery with psychological well-being, quality of life, and pain among patients with HS using validated patient-reported outcome measures. Methods: We conducted a analytical cross-sectional study between January 2024 and January 2025 at King Saud University Medical City, Riyadh, Saudi Arabia. Consecutive adult patients with HS were enrolled after informed consent. Disease severity was assessed using Hurley staging. Participants completed the Dermatology Life Quality Index (DLQI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and a visual analog scale (VAS) for pain. Outcomes were compared between patients with and without prior bariatric surgery using independent t-tests and general linear models adjusted for age, sex, Hurley stage, and diagnostic delay. Results: Among 135 participants, 77 (57.0%) were female and 15 (11.1%) had undergone bariatric surgery. Patients with prior bariatric surgery had lower mean DLQI (8.13 vs 8.62), PHQ-9 (5.73 vs 7.50), GAD-7 (5.87 vs 6.31), and VAS pain (2.80 vs 3.69) scores than those without surgery; however, these differences were not statistically significant after adjustment (all p> 0.05). DLQI correlated positively with PHQ-9 (r=0.334) and GAD-7 (r=0.323), while pain correlated moderately with DLQI (r=0.546; p< 0.001). Conclusion: In this cross-sectional sample, prior bariatric surgery was not associated with statistically significant differences in quality of life, depressive symptoms, anxiety symptoms, or pain after adjustment. However, patients with prior bariatric surgery showed consistently lower mean scores across these outcomes. Larger prospective longitudinal studies with more detailed surgical subgroup data are needed to determine the magnitude and durability of any potential benefit. Keywords: hidradenitis suppurativa, acne inversa, bariatric surgery, quality of life, dermatology life quality index, depression, patient health questionnaire-9