Screening For Common Hidradenitis Suppurativa Comorbidities

Reviewed by: HU Medical Review Board | Last reviewed: December 2020

Four out of five people with hidradenitis suppurativa (HS) have at least one comorbidity, according to a global patient survey published in 2020. Comorbidities are 2 or more disorders in the same person. Comorbid illnesses can interact in ways that worsen both.1,2

HS is a painful, chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps on the skin. Over time, this leads to symptoms like abscesses, pus, inflammation, and tunnels under the skin. Sporadic flares make symptoms worse.3,4

Since HS causes chronic inflammation within the body, the comorbid conditions of HS are ones that are known to be caused by this as well. While people with HS may experience many different comorbidities, some are more common than others.

The Global Survey of Impact and Healthcare Needs (VOICE) study found that people with HS had twice as many comorbidities as people who did not have HS. There are several comorbid conditions in HS. It is important to discuss these conditions with your doctor so you have a plan for managing them along with your HS.1

Depression and anxiety

The HS comorbidities most often reported in the Global VOICE project were anxiety and depression. About 1 in 3 people with HS said they had anxiety or depression or both.1

The physical appearance of the skin lesions in HS can lead to a negative self-image. Plus, the lesions in HS may smell bad, which can add to the emotional impact of the disease. Friends and family may not fully understand the disease. This can lead to feelings of embarrassment and isolation.5

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In a multicenter study, people with HS rated their quality of life similar to people with rheumatoid arthritis pain, cardiovascular disease, cancer, liver disease, and chronic obstructive pulmonary disease. Poor quality of life may lead to depression and anxiety, which, in turn, may further reduce quality of life.6

Chronic pain

The pain associated with HS can seem unbearable and may cause chronic disability. To make matters worse, chronic pain in HS may go untreated or not be managed well. A lack of research and understanding of the condition has made pain management difficult for people HS.5

Metabolic syndrome and cardiovascular disease

People with HS are nearly 4.5 times more likely to have metabolic syndrome than healthy people without HS. Metabolic syndrome includes:7,8

  • Large waist size
  • Abnormal triglyceride (fat in the blood) or cholesterol levels
  • High blood pressure
  • High blood sugar

The syndrome increases the risk of heart disease, stroke, and type 2 diabetes.7,8

Each of these 3 related comorbidities increases the risk of cardiovascular disease. Research found a notably increased risk of major adverse cardiovascular events (things like heart attacks, stroke, and heart disease) and cardiovascular death in people with HS, compared to people without HS. Plus, compared with the general population, people with HS are nearly 3 times more likely to have diabetes.9,10

Up to 88 percent of people with HS are obese, and obesity increases the severity of HS. Weight reduction appears to relieve HS symptoms, as well as reduce cardiovascular and diabetes risks.7,11


People with HS have a higher risk of spondyloarthritis, an inflammatory condition that involves the joints, ligaments, and tendons. In most cases, it mainly affects the spine. The link works both ways – more people with spondyloarthritis have HS than in the general population.11,12

HS is common among people with rheumatological symptoms, especially Afro-Caribbean men. Rheumatological diseases, including arthritis, involve inflammation and loss of function affecting joints, tendons, ligaments, bones, and muscles.13,14

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is 4 to 8 times more common in people with HS than in the general population. People with IBD are 9 times more likely to develop HS.7

HS is clearly linked to higher risk of Crohn’s disease and ulcerative colitis, both of which are forms of IBD. Patients with a perianal fistula (abnormal tunnel between the anal canal and skin around the anus) have a high rate of HS.11,15

HS is also linked to pyoderma gangrenosum, which is an IBD complication. Pyoderma gangrenosum is a skin disorder with deep chronic ulcers and pus.7,16

Polycystic ovarian syndrome

According to an analysis of a very large study published in 2018, women with HS are twice as likely to have polycystic ovarian syndrome (PCOS) than those without HS. PCOS is a hormonal disorder marked by high levels of androgen (male hormone) in women, irregular menstrual periods, and cysts on the ovaries.17,18

Follicular occlusion tetrad

HS has been linked to 3 other inflammatory skin diseases that begin with blocked hair follicles. Together with HS, these conditions form the follicular occlusion tetrad. The occurrence of all 4 conditions at once is uncommon.7,19-21

The 4 diseases are:7,19-21

  • HS
  • Acne conglobata (severe, scarring acne)
  • Pilonidal sinus (a tunnel at the cleft between the buttocks)
  • Scalp cellulitis (scalp infection that evolves to scarring and hair loss)

Squamous cell carcinoma

Squamous cell carcinoma (SCC) has been reported in or near HS lesions. SCC is a cancer that affects the epidermis, which is the top layer of skin.7,22

The risk with HS seems to be most often in the buttocks, the genitals, and the area around the anus. It typically occurs in men with severe disease that has lasted a long time. The cancers are often linked with high-risk human papillomavirus (HPV) infection. Delayed diagnosis leads to a poor outcome.7,13

The importance of screening for HS comorbidities

Using suitable tools and tests to screen for common comorbidities helps your doctor and care team reduce your symptoms and progression of HS, along with related conditions. Managing your physical, mental, and emotional health will help decrease your risk of these conditions. Have open and honest talks with your doctor to make sure you are getting the screening and health resources available to you.