Patient Perspectives on Hidradenitis Suppurativa-induced Scarring and Laser Therapy

Appendix 1: The Impact of Hidradenitis Suppurativa-Induced Scarring on Quality of Life Survey

The Impact of Hidradenitis Suppurativa-Induced Scarring on Quality of Life Survey

1. What is your age? _____________

2. What is your gender? ____________

3. Are you of Hispanic, Latino, or of Spanish origin?

   • Yes

   • No

   • Prefer not to answer

4. How would you describe yourself? Check all that apply.

   • American Indian or Alaska Native

   • Asian

   • Black or African American

   • Native Hawaiian or Other Pacific Islander

   • White

   • Other (please specify): _____________

   • Prefer not to answer

5. How long have you had HS?

   • <1 year

   • 1-3 years

   • 3-5 years

   • 5-10 years

   • >10 years

6. How would you describe your HS disease severity?

   • Mild

   • Moderate

   • Severe

7. Where does HS affect you? Check all that apply.

   • Axilla (underarms)

   • Groin (pubic hairline/ genitals)

   • Inguinal (bikini line/ creases)

   • Upper inner thigh

   • Inframammary (below breasts)

   • Infra-abdominal (below stomach/ stomach folds)

   • Buttocks

   • Pilonidal

   • Face

   • Neck

   • Other (please specify): ______________

8. What treatments have you received for HS? Check all that apply.

   • Topical antibiotics (clindamycin gel/lotion, Hibiclens)

   • Oral Antibiotics (rifampin, metronidazole, levofloxaxin, doxycycline, Bactrim, etc.)

   • IV antibiotics (ertapenem, ceftazidime/avibactam, vancomycin/zosyn)

   • Hormonal agents (finasteride, spironolactone, oral contraceptives/birth control)

   • Biologics (Humira, Infliximab, Skyrizi, etc.)

   • Injections (intralesional [directly into lesions], intramuscular [directly into buttocks])

   • Oral retinoids: Isotretinoin (Accutane), acitretin

   • Incision & Drainage

   • Surgery

   • Laser hair removal

   • Other (please specify): _____________

9. HS scars interfere with your participation in the following activities (check all that apply):

   • Physical activity/Sports/Working out/Dancing

   • Going to the beach or pool

   • Wearing a bathing suit

   • Wearing clothing of your choice

   • Wearing certain fabrics

   • Grooming (eg, shaving, waxing, deodorant)

   • Using certain skin products (eg, body soap, lotion, perfume)

   • Working

   • Hobbies

   • Being intimate with sexual partner

   • Other (please specify): _________

10. HS scars interfere with your social life by limiting your ability to (check all that apply):

    • Socialize with friends and family

    • Attend events or parties

    • Go out in public

    • Other (please specify): _________

11. HS scars interfere with your romantic life by limiting (check all that apply):

    • Dating

    • Meeting new partners

    • Sexual activity

    • Other (please specify): _________

12. HS scars negatively impact your (check all that apply):

    • Self-esteem

    • Overall quality of life

    • Mood

    • Self-confidence

    • Outlook on life

    • Other (please specify): _________

13. Which physical manifestation of HS bothers you the most? Rank from 1-6, with 1 being the most bothersome and 6 being the least bothersome.

    • _____ Scars

    • _____ Dyspigmentation

    • _____ Odor

    • _____ Draining

    • _____ Pain

    • _____ Other (please specify): _________

14. What bothers you the most about your HS scars in general? Rank from 1-6, with 1 being the most bothersome and 6 being the least bothersome.

    • ______ Color

    • ______ Texture

    • ______ Pain

    • ______ Restriction in movement

    • ______ Limitation of daily activities

    • ______ Other: (please specify): _________

15. How often do your HS scars interfere with your day-to-day life?

    • Every day

    • Most days

    • Some days

    • Rarely

    • Never

Questions 16-18 are on whether you agree with the following statements.

1. My HS scars have a negative impact on my mental health.

   • Strongly Disagree

   • Disagree

   • Neither Agree nor Disagree

   • Agree

   • Strongly Agree

2. My HS scars have a negative impact on my self-esteem.

   • Strongly Disagree

   • Disagree

   • Neither Agree nor Disagree

   • Agree

   • Strongly Agree

3. My HS diagnosis has made me a stronger person.

   • Strongly Disagree

   • Disagree

   • Neither Agree nor Disagree

   • Agree

   • Strongly Agree

4. Have you heard about the use of laser therapy for treating HS-related scarring?

   • Yes

   • No

5. What do you know about laser therapy?

______________________________________________________________

1. Would you be willing to try laser therapy for HS scar reduction?

   • Yes

   • No

2. If you answered No to question 21, please specify why:

_______________________________________________________________

1. If you answered Yes to question 21 and insurance does not cover laser treatment, which of the following ways would you be willing to cover the costs of the laser?

   • Out-of-pocket payment up to 50 per month

   • Out-of-pocket payment up to 100 per month

   • Out-of-pocket payment up to 500 per month

   • Out-of-pocket payment up to a certain amount per month. Please specify: _________

   • Out-of-pocket payment- any cost

   • Other (please specify): ________________

2. Which of the following therapies would you be willing to try for HS scar reduction? (check all that apply):

   • Topical therapy

   • Steroid injections

   • Laser

   • Surgical procedures

   • Other (please specify): ________________