Palliative and Supportive Care Needs in Advanced Hidradenitis Suppurativa: A Systematic Review

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with severe symptom burden, high psychiatric comorbidity, and profound impairment in health-related quality of life (HRQoL). Despite the disease burden, no systematic synthesis has characterized the palliative and supportive care needs of this population. This review aimed to synthesize evidence on the palliative and supportive care needs of adults with advanced HS, to evaluate validated patient-reported outcome measures applicable to this domain, and to characterize unmet needs and barriers to care. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered on the International Prospective Register of Systematic Reviews (PROSPERO). Studies reporting palliative care-relevant outcomes in adults with HS were included. Quality was appraised using Joanna Briggs Institute (JBI) Prevalence Checklists, Newcastle-Ottawa Scale, and Critical Appraisal Skills Programme (CASP) tools. Seven studies (sample sizes ranging from 77 to 1,787; conducted across 27 countries; published between 2020 and 2025) were included. Across included studies, 61.4% (n = 798/1,299) of the patients experienced moderate-to-severe pain, while drainage and fatigue were reported by 71.8% (n = 933/1,299) and 61.0% (n = 793/1,299), respectively. Depression was present in 30.3-35.8% of participants (from 154/508 to 465/1,299) and anxiety in 36.2-57.5% (from 470/1,299 to 292/508); suicidal ideation was reported by 7.9% (n = 103/1,299) and suicidal attempt by 4.2% (n = 55/1,299). Sexual dysfunction affected 60.8% (n = 45/74), and hindered sexuality affected 61.8% (n = 47/76). Only 4.5% (n = 24/529) of adults achieved complete disease control despite active dermatologist treatment. Emotional burden consistently exceeded physical symptom burden. Caregiver needs, spiritual concerns, and advance care planning remain unstudied. Adults with advanced HS carry a multidimensional, unmet palliative and supportive care burden, underscoring the importance of integration of psychological screening, sexual health assessment, and pain management protocols.