The Impact of Bariatric Surgery on Patient-Reported Outcomes in Hidradenitis Suppurativa

A cross-sectional study from Saudi Arabia found that patients with hidradenitis suppurativa (HS) who previously underwent bariatric surgery reported numerically lower levels of pain, anxiety, depression, and quality-of-life impairment compared with patients who had not undergone surgery.¹

Background

HS is strongly associated with obesity and carries a substantial psychosocial burden. Because obesity has also been linked to increased HS severity, weight reduction is often considered an important component of disease management. However, previous studies examining the impact of bariatric surgery on HS outcomes have produced inconsistent findings.

Prior research has suggested that weight-loss surgery may improve HS severity, pain, and quality of life through reductions in friction, systemic inflammation, and metabolic stress. Some reports have also documented partial or complete disease remission after substantial weight loss.² However, other studies have described worsening HS following bariatric surgery, particularly after rapid postoperative weight loss or procedures associated with excess skin folds and nutritional deficiencies. Redundant skin may increase friction and moisture retention in intertriginous areas, potentially exacerbating HS symptoms. Some patients in previous studies reportedly improved after panniculectomy, suggesting excess skin removal may influence outcomes.³

Study Design

The study evaluated the association between bariatric surgery and patient-reported outcomes among adults with HS treated at King Saud University Medical City in Riyadh between January 2024 and January 2025. The research included 135 adults with clinically confirmed HS. The median patient age was 34 years, and 57% were female. Most participants had obesity, with a mean body mass index of 31.2 kg/m². Approximately 11.1% of the cohort (n = 15) had undergone bariatric surgery. Sleeve gastrectomy accounted for nearly all procedures, with only 1 patient reporting Roux-en-Y gastric bypass.

Disease severity was assessed using Hurley staging. Hurley stage II disease was the most common, accounting for 40.7% of cases, while stages I and III each represented 29.6% of the cohort. Participants completed several validated patient-reported outcome measures, including the Dermatology Life Quality Index (DLQI), the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) scale, and a visual analog scale (VAS) for pain.

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Trends and Results

Patients with prior bariatric surgery consistently demonstrated lower mean scores across all outcome measures. Mean DLQI scores were 8.13 in the bariatric surgery group compared with 8.62 in patients without surgery. Mean PHQ-9 scores were 5.73 versus 7.50, respectively, while GAD-7 scores were 5.87 versus 6.31. Mean pain scores measured by VAS were also lower in the bariatric group at 2.80 compared with 3.69 in controls.

Despite these trends, none of the differences reached statistical significance after adjustment for age, sex, Hurley stage, and diagnostic delay. Adjusted analyses similarly showed no independent association between bariatric surgery and improved patient-reported outcomes.

Adjusted mean DLQI scores were 7.82 in the bariatric surgery group and 8.72 in controls. Adjusted PHQ-9 scores were 5.93 and 7.28, respectively. Anxiety scores were nearly identical after adjustment, while pain scores remained numerically lower among patients with prior surgery but did not achieve significance.

DLQI scores showed weak but statistically significant positive correlations with both depressive symptoms and anxiety symptoms. Pain severity demonstrated the strongest relationship with impaired quality of life, with a moderate positive correlation between VAS pain scores and DLQI scores. Pain also correlated significantly with both depression and anxiety scores, although these associations were weaker. The authors noted that pain may serve as a practical clinical marker for broader psychological distress in patients with HS.

Next Steps

The authors suggested that the absence of statistically significant findings in the current study may reflect the complex balance between potential benefits and risks associated with bariatric surgery in HS. Improvements related to weight reduction may be offset in some patients by persistent scarring, chronic pain, nutritional changes, or postoperative skin-related complications. Future research should evaluate how procedure type, weight-loss magnitude, and postoperative management influence both clinical symptoms and quality of life in this patient population.

References

1. Alsukait S, Alotaibi H, Alkofide M, et al. Impact of Bariatric Surgery on Quality of Life and Psychological Well-Being Among Patients with Hidradenitis Suppurativa: A Cross-Sectional Study. Clinical, Cosmetic and Investigational Dermatology, 19. 2026. doi:10.2147/CCID.S584656

2. Chierici A, Bulsei J, Alromayan M, et al. Bariatric surgery reduces the incidence of hidradenitis suppurativa in individuals with obesity: results of a nationwide administrative data study in France. Surg Obes Relat Dis. 2024;20(10):947-952. doi:10.1016/j.soard.2024.03.014

3. Garcovich S, De Simone C, Giovanardi G, Robustelli E, Marzano AV, Peris K. Post-bariatric surgery hidradenitis suppurativa: a new patient subset associated with malabsorption and micronutritional deficiencies. Clin Exp Dermatol. 2019;44(3):283-289. doi:10.1111/ced.13732