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If you’re living with hidradenitis suppurativa (HS), you already have a lot to manage with your skin. Sometimes, an illness like the flu or COVID-19 can trigger a flare or make symptoms harder to handle for a while. It may feel like your immune system is on high alert.
In this article, we’ll talk about how other health problems can trigger HS flare-ups or make them worse. We’ll explain why illnesses that affect the immune system can also worsen long-term skin conditions like HS. Finally, we’ll share tips for taking care of yourself when you’re sick and for managing comorbidities (more than one health condition at the same time) while living with HS.
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The short answer is yes. When you come down with the flu, a sinus infection, or even a stomach bug, your immune system responds by producing extra inflammation to fight off germs. For someone with HS, this increased inflammation can spread to the skin. As a result, you may develop new nodules, abscesses, or lesions.
Other health problems, like inflammatory bowel disease (IBD), psoriasis (another skin disease), or metabolic syndrome, can have a similar effect. These conditions also involve long-term inflammation, which can make HS symptoms more intense or harder to control. When your body’s defensive systems are working overtime, HS may respond with more inflammation — often showing up as increased pain or new skin lesions.
When you get sick, your immune system releases chemical messengers called cytokines to fight infection with inflammation. These signal proteins help destroy germs. In people with HS, the immune system already makes too many cytokines, even when you’re not sick.
Researchers think the immune pathways that help the body fight infection may also play a part in HS flare-ups. Two key cytokines involved in HS are tumor necrosis factor-alpha (TNF-alpha) and interleukin-17 (IL-17). Think of them as alarm signals that rally the body’s defensive cells. TNF-alpha and IL-17 help fight viruses and bacteria, but too much of them can irritate sweat glands and hair follicles and trigger flare-ups.
During the COVID-19 pandemic, researchers learned more about how infections affect people living with HS. In a large study, about 1 in 5 people with HS had a flare-up within a few weeks of getting COVID-19. Some people also developed new HS lesions for the first time. This finding suggests that COVID-19 may even trigger HS in people who have never shown symptoms before.
The study also found that people already taking biologic medications (made from living cells), such as adalimumab, were much less likely to have a flare. These treatments help quiet the immune system, preventing it from overreacting when the body fights off viruses. Researchers noted that participants who had flare-ups after COVID-19 reported higher disease scores and worse quality of life.
The same study that looked at COVID-19 and HS flare-ups also looked at how vaccination affects people with HS. Researchers found that people with HS who were vaccinated against COVID-19 were significantly less likely to develop flare-ups or new lesions after a COVID-19 infection. In fact, COVID-19 vaccination reduced the risk of HS flare-ups by as much as 98 percent.
Doctors believe vaccines help by keeping the immune system more balanced. Instead of triggering a full inflammatory response to fight infection, vaccination teaches the immune system to recognize the virus early and react more calmly. For people with HS, whose immune systems are already more likely to overreact, this can help keep added inflammation from reaching the skin. Staying up to date on vaccines may not only protect against serious illness but may also help control HS symptoms during infections.
IBD, which includes Crohn’s disease and ulcerative colitis, can make HS more active. Both of these conditions involve an overactive immune system and high levels of inflammation, which can affect different parts of the body. In IBD, the immune system attacks the digestive tract. In HS, it targets the hair follicles and nearby sweat glands.
One study found that people with IBD are nine times more likely to get HS than those in the general population. Researchers believe that immune system changes, genetic factors, and differences in the microbiome (the body’s natural bacterial environment) may raise the risk for both conditions.
Another study reinforced theories about the connection between IBD and HS. The researchers found that IBD and its subtypes raise the risk of developing HS. However, the reverse wasn’t true: HS didn’t appear to cause IBD or make it worse. The findings suggest that shared immune pathways and interactions through the gut-skin axis may explain why some people develop both conditions.
Living with a chronic (long-term) skin condition can be challenging enough on its own. When you also have an infection or illness, it can make things feel even harder. Here are a few tips for keeping HS under control when you’re recovering from another illness at the same time.
Always stick to your HS treatment plan as provided by your doctor. This may include biologic medications or other types of medicines, like retinoids, steroids, or antibiotics. Stopping treatment suddenly can cause the immune system to rebound, leading to new flare-ups. Certain biologic treatments may also help control other inflammatory diseases at the same time. Some infections may require pausing your HS treatment to successfully treat the infection.
When you’re living with more than one chronic condition, it helps to stay in close communication with your healthcare providers. Your healthcare team might include:
Be sure to share updates with all members of your healthcare team as your treatment plan changes. Some medicines for one illness can affect another, so coordination helps avoid conflicts and improves safety.
Healthy routines can help prevent inflammation from building up. Get enough sleep, eat balanced meals, and stay as active as your body allows. Managing stress through relaxation can also calm the immune system. Avoid smoking and limit alcohol, as both can make inflammation worse and slow down healing.
Caring for your skin properly can help reduce irritation when your body is under extra stress. Use only mild, fragrance-free antimicrobial cleansers on your skin. Avoid harsh scrubbing or tight clothing that traps sweat. If shaving causes irritation, consider laser hair removal. During illness or a flare-up, keep lesions clean and dry. Contact your dermatologist if you notice new or worsening problems related to your skin or joints.
Pay attention to small changes in your skin. Illness isn’t the only trigger for a flare-up. Other common triggers include:
As many as 30 percent of people with HS will experience flares weekly or monthly. However, avoiding these triggers can reduce the risk. If something feels off, reach out to your doctor sooner rather than later. The two of you can work together to keep HS and any other health conditions under control.
When you come down with an infection or another inflammatory condition, your immune system can ramp up in ways that also set off HS. That’s why flares may show up during infections or alongside conditions like IBD. Sticking with your treatment plan, keeping your care team updated, and resting as you recover can help limit HS flare-ups during illness. If flares start or symptoms change, checking in early with your dermatologist can make a big difference.
On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.
Did your HS flare the last time you got sick? What helped you the most? Let others know in the comments below.
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