Evaluation of public perception towards patients with hidradenitis suppurativa and atopic dermatitis

Hidradenitis suppurativa (HS) and atopic dermatitis (AD) are chronic inflammatory cutaneous disorders associated with psychosocial distress. The stigma of HS and AD often creates a burden on patients, leading to a negative self-image and higher rates of anxiety and depression.1-3 However, few studies investigate the general public's endorsement of stigmatizing attitudes towards people with cutaneous diseases.4, 5 We aimed to analyze the perception towards individuals with HS and AD and evaluate factors leading to higher rates of stigmatization. A 51-question survey was distributed to subjects over the age of 18 on the online survey recruitment platform Amazon Mechanical Turk (MTurk). To improve survey reliability, a series of four screening questions testing participants' attentiveness were randomly embedded throughout the survey. Patients were ineligible for the study if they answered one of the screening questions incorrectly. The survey displayed two images each of moderate-to-severe HS and AD and then examined participants' attitudes towards these images. The questions measuring stigma were separated into three categories based on previous studies4, 5: Desire to Social Distance, Stereotype Endorsement and Belief in AD Myths. Each question was scored on a 1–5 Likert scale, with 1 being the most stigmatizing attitude and 5 the least. Responses that were scored as a 1 or 2 were considered as the endorsement of stigmatizing attitudes when completing statistical analysis. Fisher's exact test was used to compare differences in attitudes towards patients with HS versus AD, and patients currently affected or with a history of HS/AD versus those with no history of HS/AD. A total of 497 participants responded to the survey, of which 350 answered the screening questions correctly (70% response rate, Table 1). Participants reported not feeling comfortable hiring someone with HS and AD (17.4% vs. 18.3%, p = 0.8), believing patients with HS and AD have poor hygiene (27.7% and 28.0%, p = 0.9) and endorsed the myth that people with HS and AD are to blame for their condition (64.3% vs. 64.6%, p = 1.0, Table 2). There was a minimal difference in the stigma towards individuals with HS versus AD. Survey respondents had more stigmatizing attitudes towards wanting to date an individual with AD compared to HS (mean Likert score 3.49 vs. 3.68, p = 0.03), and this was the only statistically significant difference when comparing average Likert scores towards individuals with HS versus AD. Participants not currently affected or without a history of HS or AD had more stigmatizing attitudes compared to individuals with a history of HS or AD (p < 0.0001, Table 2). Patients with HS and AD often experience reduced quality of life, which is in part due to the perceived stigma of having cutaneous disease. Our study is limited by self-reported outcomes recorded via MTurk crowdsourcing software. Still, the findings set the foundation for future research on the negative biases towards patients with HS and AD. Moreover, participants with a history of HS or AD were less likely to have stigmatizing viewpoints towards HS and AD individuals. Increasing health education initiatives directed toward the general public on the causes and treatments for HS and AD may reduce the stigma of these cutaneous diseases. Study conception and design: Jonathan D. Greenzaid, Matthew C. Johnson and Steven R. Feldman. Data collection: Jonathan D. Greenzaid and Matthew C. Johnson. Analysis and interpretation of results: Jonathan D. Greenzaid, Matthew C. Johnson and Steven R. Feldman. Draft manuscript preparation: Jonathan D. Greenzaid. All authors reviewed the results and approved the final version of the manuscript. S. R. F. has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alovtech, vTv Therapeutics, Bristol-Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, Leo Pharma, Mylan, Celgene, Ortho Dermatology, Menlo, Merck & Co, Qurient, Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Teladoc, BMS, Ono, Micreos, Eurofins, Informa, UpToDate and the National Psoriasis Foundation. He is founder and part owner of Causa Research and holds stock in Sensal Health. The remaining authors declare no conflicts of interest. Reviewed and approved by Wake Forest University Health Sciences IRB IRB00075066. 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.