What diseases are associated with HS?

Hidradenitis suppurativa (HS) is a long-term skin condition characterized by the occurrence of painful abscesses and scarring on the skin. HS is associated with several other diseases and conditions, primarily inflammatory and autoimmune disorders. Understanding the comorbidities of HS can help patients and doctors better manage symptoms and reduce complications.

Table of Contents

Inflammatory Diseases

HS is often described as a chronic inflammatory skin disease. Inflammation driven by the immune system likely contributes to the development of painful HS lesions. HS is associated with multiple other inflammatory conditions:

Inflammatory bowel disease (IBD) – HS occurs in up to 33% of patients with IBD, which includes Crohn’s disease and ulcerative colitis. Chronic inflammation in the digestive tract may promote inflammation in the skin as well.
Pyoderma gangrenosum – This rare inflammatory skin condition causes large painful ulcers, usually on the legs. About 20% of patients with pyoderma gangrenosum also have HS.
Psoriasis – An estimated 11-40% percent of patients with HS also have psoriasis. Psoriasis causes red, scaly patches on the skin. Both conditions involve irregular immune activation in the skin.

Rheumatoid arthritis – This autoimmune and inflammatory arthritis occurs in up to 10% of HS patients. Joint inflammation in rheumatoid arthritis has similarities to the skin inflammation in HS.
Spondyloarthropathy – Up to 13% of people with HS also have this type of arthritis that causes inflammation in the joints of the spine. Genetic factors may link the two conditions.

The association between HS and multiple inflammatory diseases involving the gut, skin, and joints underscores the systemic nature of inflammation in HS. Managing inflammation through lifestyle changes, medications, and/or surgery may help improve multiple diseases simultaneously.

Metabolic Conditions

HS is associated with several metabolic conditions, particularly those linked to obesity:

Obesity – Approximately 30-50% percent of patients with HS are obese. Excess weight is the strongest modifiable risk factor for HS.
Type 2 diabetes – HS patients have up to a 4-fold increased risk of developing type 2 diabetes compared to the general population.

Dyslipidemia – Abnormal blood lipid levels, including high cholesterol and triglycerides, occur more often in patients with HS.
Metabolic syndrome – HS is up to 8 times more likely in people with a cluster of conditions including obesity, high blood pressure, and insulin resistance that make up metabolic syndrome.

The association between HS and metabolic disorders relates to underlying chronic inflammation compounded by obesity. Losing weight, improving nutrition, and managing related conditions may help reduce HS severity. Medications that improve insulin sensitivity and lower inflammation may also benefit HS.

Mental Health Conditions

HS takes a significant toll on mental health and quality of life. HS is associated with increased rates of several mental health conditions:

Depression – Up to 44% of patients with HS may suffer from major depression relating to chronic pain, odor, drainage, and isolation.
Anxiety – Symptoms of anxiety occur in up to 48% of HS patients, stemming from social anxiety and fear of HS flares.

Suicidal ideation – Chronic HS was associated with suicidal thoughts in up to 9% of patients in one study.

Mental health treatment through counseling, therapy, and/or medication alongside HS treatment can help improve a patient’s overall well-being. Identifying and managing mental health conditions is key for HS patients.

Pain Disorders

The painful, draining lesions and abscesses of HS understandably lead to higher rates of certain pain disorders:

Chronic widespread pain – Up to 50% of HS patients suffer from chronic widespread muscle and joint pain.
Fibromyalgia – This condition characterized by chronic widespread pain and tenderness occurs in up to 26% of HS patients.
Chronic fatigue syndrome – Approximately 20% of people with HS also experience this disabling fatigue.

Migraine headaches – HS patients have up to a 3-fold increased prevalence of migraines compared to the general public.

The reason for increased pain disorders in HS is unclear but likely relates to systemic inflammation. Managing pain through integrative approaches including physical therapy, stress reduction, and pain medications can improve quality of life.

Cardiovascular Disease

HS is associated with an increased risk of certain cardiovascular conditions:

Coronary artery disease – Patients with HS have a 1.5-fold increased risk of coronary heart disease.
Stroke – One study found the risk of stroke was doubled in HS patients.
Deep vein thrombosis – HS was linked to a 3 to 4 times higher risk of dangerous blood clots in the legs.

It is unclear whether HS directly leads to cardiovascular disease, or whether shared risk factors like inflammation, obesity, smoking, and inactivity contribute to both conditions. Treating those risk factors could reduce cardiovascular risk in HS patients.

Autoimmune Diseases

The immune system dysfunction in HS also associates the condition with several autoimmune disorders:

Vitiligo – This autoimmune skin condition causes depigmentation and occurs in up to 6% of HS patients.

Alopecia areata – Some studies have found this autoimmune hair loss condition in up to 18% of people with HS.
Thyroid disorders – Up to 14% of HS patients have hypothyroidism or hyperthyroidism.
Systemic lupus erythematosus – This multi-system autoimmune disease occurs alongside HS, likely due to shared genetic risks.

While the links between HS and autoimmune conditions could relate to chance, shared genes likely contribute. Screening for autoimmune disorders in HS patients could lead to earlier diagnosis and treatment.

Other Associated Conditions

HS has numerous other associations as well:

hidradenitis suppurativa – Up to 40% of patients develop painful acne-like bumps on the buttocks and upper thighs.

Polycystic ovarian syndrome (PCOS) – HS occurs in around 22% of women with PCOS, linked to hormone imbalances.
Cancer – HS may slightly increase risks of certain cancers like breast and hematologic malignancies.
Keratosis pilaris – HS co-occurs in 30% of patients with this common skin condition causing rough bumps on the arms.

Dissecting cellulitis – This inflammatory condition causes swelling and nodules on the scalp in up to 18% of HS patients.

Research into these and other associations is ongoing. Screening HS patients for additional conditions can optimize overall care.

Conclusion

In summary, hidradenitis suppurativa is associated with a wide array of medical conditions. These primarily include other inflammatory diseases, metabolic disorders like obesity and diabetes, mental health conditions, pain disorders, cardiovascular disease, and autoimmune conditions. The systemic inflammation and immune dysfunction of HS likely underlies these associations.

Understanding the potential comorbidities of HS allows for screening and early treatment. A holistic approach managing both HS and any associated conditions is key to improving a patient’s prognosis and quality of life. Lifestyle changes like weight loss, pain management, and therapy alongside medications and surgery offer the best outcomes.