Topic 5: Look Beyond Skin Findings

HS can interfere with school attendance, concentration, sleep, sports, clothing choices, friendships, body image, dating, and emerging independence. In a 2025 pediatric study, quality-of-life impairment was associated with clinical disease characteristics, supporting routine assessment of burden rather than relying on lesion counts alone.⁵

A large 2024 study of chronic pediatric skin disorders found substantial stigma and mental-health effects; children with HS and hyperhidrosis were among those most likely to report increased depression and anxiety.⁶

Ask directly but sensitively about:

• Pain, drainage, odor, dressings, and sleep
• Missed school, difficulty sitting in class, changing for sports, or concentrating
• Avoiding activities, locker rooms, social events, or close relationships
• Bullying, teasing, unwanted attention, or fear that others will notice drainage or odor
• Embarrassment, anxiety, low mood, hopelessness, or self-harm thoughts
• What the adolescent wants to be different—not only what the caregiver or clinician wants