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Managing Comorbidities in HS

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

Hidradenitis suppurativa (HS) is a chronic, painful skin condition. The disease begins when clogged hair follicles cause bumps on the skin. However, just because the symptoms of HS are seen on the skin does not mean that it is only a skin condition.

Doctors are still trying to figure out the exact causes of HS. Long-term irritation or inflammation within the body are thought to be major reasons why HS happens. In HS, this irritation inside the body is never turned off. This causes the body to show its irritation by the symptoms on the skin.

Doctors use the term comorbidity to describe a condition or illness that occurs at the same time of another condition or illness. Comorbid illnesses can interact in ways that worsen both. Morbidity should not be confused with the term mortality. Morbidity means disease or illness and mortality means death.1

A global patient survey published in 2020 found that 4 out of every 5 people with HS have at least 1 comorbidity. There are several comorbid conditions in HS. Make sure and discuss these conditions with your doctor so you can have a plan for managing these potential conditions.2

Comorbidity and HS

Because HS causes chronic irritation or inflammation within the body, the comorbid conditions of HS are also 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. They include:

  • Depression and anxiety
  • Chronic pain
  • Metabolic syndrome and cardiovascular disease
  • Arthritis
  • Inflammatory bowel disease
  • Polycystic ovarian syndrome (PCOS)

Depression and anxiety

Depression and anxiety are common comorbidities in HS. The physical appearance of the skin lesions in HS can lead to a negative self image. Additionally, the lesions in HS may smell bad, adding to the emotional impact of the disease.3

Friends and family may not fully understand the disease. This can lead to feelings of embarrassment and isolation. It is important to talk to your doctor about the feelings you have about your condition. No feeling is wrong, and there is help available.

Chronic pain

HS is a very painful condition. The pain associated with HS can seem unbearable and cause chronic disability. To make matters worse, chronic pain in HS may go untreated or not managed well. Lack of research and overall understanding of the disease has made pain management difficult in HS.3

Managing your pain with HS is important, and you may often need more than 1 doctor or therapy to find what works for you.

Metabolic syndrome and cardiovascular disease

Metabolic syndrome and cardiovascular disease often exist with HS.

Metabolic syndrome includes:4,5

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

Cardiovascular disease is the dysfunction of the vessels and the heart. Cardiovascular disease is the leading cause of death in the United States. Cardiovascular disease includes conditions such as:6

  • Heart disease
  • Heart attack
  • Stroke
  • Heart failure
  • Abnormal heart rhythms
  • Heart valve problems

The inflammation inside the body that occurs with HS also causes damage to the body’s blood vessels. Long-term damage of vessels within the body leads to the body’s overreaction to try to repair itself. It is this attempt at repair that causes further inflammation and increases the risk for heart and vessel disease.7

HS has been associated with increased body weight. Being overweight carries an additional risk for cardiovascular disease, which increases the likelihood of it occurring along with HS. Talk to your doctor about how to maintain a healthy weight to protect yourself from risk.6


HS has been associated with a high rate of ankylosing spondylitis, an inflammatory condition that involves the joints, ligaments, and tendons. People with HS are also more likely to develop psoriatic arthritis and rheumatoid arthritis. Researchers believe that they are comorbid conditions because they all include chronic inflammation.8

Understanding and recognizing the symptoms of inflammatory arthritis, such as morning stiffness and joint pain or swelling, can help you get a faster diagnosis and treatment.8

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. This is likely because both HS and IBD involve chronic inflammation.4

Symptoms of IBD include:4

  • Ongoing abdominal pain
  • Chronic diarrhea
  • Bloody stool
  • Unexplained weight loss

If you experience these symptoms, talk to your doctor about seeing a gastroenterologist for screening.

Polycystic ovarian syndrome

One study found that women with HS are twice as likely to have polycystic ovarian syndrome (PCOS) than those without HS. PCOS is a hormone disorder that includes high levels of androgen (male hormone) in women, irregular menstrual periods, and cysts on the ovaries.9,10

If you have any of these symptoms, talk to your doctor about getting screened for PCOS. In some cases, hormone therapy can help improve symptoms of both HS and PCOS.9,10

While comorbidities are common among those with HS, these are not universal with everyone. Managing your overall health – both physical and emotional – will help to decrease the 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.

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