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What Is The Prognosis For Hidradenitis Suppurativa?

If you have a recent diagnosis of hidradenitis suppurativa, you probably wonder about the future. How will this painful disease affect your life long-term?

Hidradenitis suppurativa, or HS, is a chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. The process leads to abscesses, pus, inflammation, tunnels under the skin, and scars. It causes pain, odor, and appearance that can reduce quality of life.1,2

Can HS be cured?

There is no cure for HS. Surgery can sometimes remove lesions (sores), with a wide margin (area around the lesions) to help prevent them from coming back. However, surgery will not stop the disease from causing new lesions to form in other locations.3

There are treatment options to reduce symptoms, relieve pain, and heal wounds. Treatment usually includes a combination of several approaches, including:1,3,4

The choice of treatment for you depends on:1,5

  • Type of lesions
  • Severity of disease
  • How often you have flares
  • Other health conditions
  • Treatment cost and availability
  • Your goals

What is the outlook?

For many people, HS is a life-long disease. Four out every 10 people with HS achieve remission, meaning a reduction or disappearance of symptoms. Remission is less likely in people who smoke or are obese.6

For more than half of people with HS, the disease has a negative effect on how they live. Their quality of life is more impaired than those with psoriasis, acne, stroke, or even heart transplant candidates.4

HS promotes social isolation. Symptoms can interfere with work, social and leisure activities, and sleep. Factors that hinder daily activities include:4,7

  • Pain
  • Itch
  • Appearance
  • Odor
  • Discharge
  • Impaired sexual health
  • Embarrassment
  • Depression
  • Anxiety

Is it fatal?

HS itself is rarely life-threatening, but risks are increased for cardiovascular death and suicide.4

Cardiovascular death

People with HS and psoriasis have a high rate of heart disease risk factors, such as:4

  • Smoking
  • Obesity
  • Metabolic syndrome
  • Diabetes
  • High cholesterol
  • Increased triglycerides (a type of fat found in the blood)

Researchers think that inflammation may link HS, psoriasis, and heart disease. The risk of cardiovascular death is 58 percent higher in people with HS than in those with severe psoriasis.8

Suicide

Depression and anxiety are common in people with HS. Nearly half of people living with the condition have reported current or former depression.7

A study in Denmark found that depression, anxiety, and drug use to relieve each condition were more common among people with HS than in the general population. In the same study, people with HS were also more likely to die by suicide.9

A study in the United States found that people with HS had more than twice the risk of suicide than people without HS.7

Managing the mental and emotional aspects of HS is an important part of treatment. Your doctor may refer you to other specialists to help improve your quality of life and reduce your risks.1,4,7,9

Written by: Ina Fried | Last reviewed: December 2020
  1. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  2. Mac Mahon J, Kirthi S, Byrne N, et al. An update on health-related quality of life and patient-reported outcomes in hidradenitis suppurativa. Patient Relat Outcome Meas. 2020;11:21-26. doi.org/10.2147/PROM.S174299.
  3. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76‐90.
  4. Tzellos T, Zouboulis CC. Review of comorbidities of hidradenitis suppurativa: implications for daily clinical practice. Dermatol Ther (Heidelb). 2020;10(1):63‐71.
  5. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28:1013-1027. doi.org/10.1016/j.bpobgyn.2014.07.012.
  6. Kromann CB, Deckers IE, Esmann S, et al. Risk-factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014 Oct;171(4):819-824. doi:10.1111/bjd.13090.
  7. Patel ZS, Hoffman LK, Buse DC, et al. Pain, psychological comorbidities, disability, and impaired quality of life in hidradenitis suppurativa. Curr Pain Headache Rep. 2017;21(12):49.
  8. Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152(4):429-434. Epub 2016 Feb 17. doi:10.1001/jamadermatol.2015.6264.
  9. Thorlacius L, Cohen AD, Gislason GH, et al. Increased suicide risk in patients with hidradenitis suppurativa. Journal of Investigative Dermatology 2018;138:52-57; doi:10.1016/j.jid.2017.09.008.