Dermatology Practical & Conceptual
Behavioral Feedback Loops and Kinesiophobia in Hidradenitis Suppurativa: A Conceptual Framework
By Jaap-Jan Roukens.
Abstract
Introduction
Hidradenitis suppurativa (HS) is a severe inflammatory dermatosis characterized by debilitating localized pain. Current HS feedback models focus on microscopic molecular networks and bacterial dysbiosis.
Objectives
This narrative review integrates the individually well-documented psychosocial and behavioral burdens of the disease into a single positive feedback model.
Methods
A macroscopic behavioral framework was conceptualized by reviewing cross-disciplinary literature regarding HS.
Results
This conceptual framework operates across three domains: i) a biomechanical-metabolic loop, where sustained immobility may accelerate the accumulation of visceral adiposity and insulin resistance; ii) a psychosocial loop, where symptom-induced psychiatric comorbidities may contribute to neuroendocrine dysregulation and compensatory coping behaviors; iii) a socioeconomic loop, where economic instability can decrease healthcare security and hinder effective disease management. Consequently, these interconnected burdens may result in increased systemic inflammation, which in turn exacerbates the pathophysiology of HS. Moreover, this review proposes kinesiophobia (the anticipatory fear of movement) as a hypothesized component of the biomechanical-metabolic feedback loop.