If you’re thinking the fatigue and flu-like symptoms you feel are linked to hidradenitis suppurativa (HS), you may be right. Around the time painful lesions or abscesses show up, you may find that you feel feverish, weak, and chilly, even when your thermometer says you’re fine.

“Up until today, I didn’t realize my fatigue could be caused by this condition, as my doctor never told me,” one myHSteam member shared.

HS is more than a skin condition. Read on to learn what’s behind symptoms of a flare-up and what you can do to feel better.

Why HS Can Cause Flu-Like Symptoms

Sometimes, you might feel sick all over, with symptoms such as nausea, headache, and fatigue. These symptoms can occur around a HS flare and may be linked to inflammation, but they aren’t always due to HS. An infection or a medication side effect can feel similar.

Infection

Watch for an HS lesion that suddenly becomes much more swollen, warm, discolored, or painful than usual. These signs can signal an infection like cellulitis. Other signs of infection may include discoloration that spreads beyond the affected area, streaks that radiate from the area, or a fever.

Drainage or pus is common with HS and doesn’t always mean you have an infection. But if the drainage changes in color, smell, or amount, contact your healthcare provider. Act quickly if this happens along with worsening pain, discoloration, swelling, or fever.

Medication Side Effects

Some medicines used to treat HS may cause nausea. These include doxycycline, clindamycin, rifampin, metformin, and pain relievers such as ibuprofen.

If you notice nausea after taking a medicine, talk with your healthcare provider or pharmacist. Taking certain medicines with food may help. Check first because some have specific instructions.

Biologics

Biologics such as adalimumab (Humira) reduce inflammation by changing how parts of your immune system work. However, these immune system changes can also increase your risk of infections.

If you develop a fever, cough, sore throat, or other signs of infection while taking a biologic, contact your dermatologist.

HS and Joint Pain

Joint pain can accompany HS for many people. In one study, 37 percent of people with HS reported joint pain, even though only about 25 percent of that group had been diagnosed with arthritis.

If you live with HS and your knees, back, hips, or other joints ache, inflammation may be part of the reason. HS is linked to inflammatory forms of arthritis, including ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis.

Other conditions, such as osteoarthritis and fibromyalgia, can also cause aches and pain in people with HS.

Joint pain doesn’t always mean you have arthritis. But always tell your doctor about ongoing pain, swelling, warmth, discoloration, or morning stiffness lasting more than 30 minutes. They may refer you to a rheumatologist for further evaluation.

Coping With Fatigue and Other Systemic Symptoms

Living with HS and fatigue can make even ordinary days harder. Strategies that may help you protect your energy, sleep better, and manage symptoms include the following:

• Try the “3 Ps” — Pace yourself by breaking larger tasks into smaller steps, prioritize what needs to get done, and plan demanding activities for times when you usually have more energy.
• Set yourself up for better sleep — Keep a regular sleep schedule, and make your bedroom cool and comfortable. Taking care of wounds and changing dressings before bed may also help reduce nighttime disruptions.
• Make your routine HS-friendly — Wear loose, breathable clothing to reduce rubbing against painful areas, and avoid smoking. If pain keeps you awake, ask your doctor about ways to manage it at night.
• Move when you feel able — Gentle walking or stretching can keep you active and may help with stiffness. On painful flare days, choose activities that don’t rub or put pressure on affected skin.
• Keep your HS treatment on track — Follow your treatment plan, and have a plan for managing flares so you know what to do when symptoms worsen.
• Pay attention to changes — Tell your doctor if fatigue or other symptoms are new, severe, getting worse, or interfering with your daily life. Fever or rapidly worsening discoloration, swelling, or pain around a lesion may need prompt medical attention.