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Conditions Related to Hidradenitis Suppurativa

Medically reviewed by Zeba Faroqui, M.D.
Written by Emily Wagner, M.S.
Posted on April 24, 2023

Many people living with hidradenitis suppurativa (HS) or acne inversa have additional health conditions that affect their quality of life. Some of these conditions may develop before an HS diagnosis, while others may show up after HS treatment or years of living with the condition.

HS is an inflammatory skin condition that causes bumps, lesions, or nodules to form on several areas of the body, including the armpits, buttocks, groin, and undersides of the breasts. In those living with chronic diseases like HS, it’s common to have other conditions at the same time. They are known as comorbidities.

This article gives an overview of the different conditions that occur alongside HS. It can be easy to assume that the symptoms from a comorbid condition are unrelated to your HS, but it’s important to keep your doctor up to date on how you’re feeling and describe any new symptoms you’re noticing. Diagnosing and treating these conditions can help alleviate your symptoms and improve your quality of life.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an umbrella term for inflammatory diseases that affect the gastrointestinal (GI) tract. The two most common types of IBD are Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any part of the GI tract, but it’s most common in the colon and small bowel. Ulcerative colitis affects only the colon (large intestine).

Symptoms of IBD include:

  • Persistent diarrhea or constipation
  • Abdominal pain and nausea
  • Bloating from gas
  • Bloody stool
  • Weight loss

Both HS and IBD are inflammatory diseases caused by an overactive immune system. Specifically, the immune system creates too much inflammation, which damages the body’s healthy tissues. In HS, your immune system attacks the hair follicles in a type of sweat gland known as the apocrine gland. In IBD, your immune system attacks the lining of your GI tract.

Studies show that HS and IBD commonly occur together. One report of more than 50,000 people living with HS found that they were three times as likely to develop Crohn’s disease compared to those without HS. Age, race, and smoking status were all shown to play a role. Specifically, white people between ages 45 and 64 who smoke tobacco were found to be at the highest risk of developing Crohn’s disease.

Crohn’s disease and HS also have overlapping perianal symptoms. For example, Crohn’s can cause:

  • Anal fissures — Tears in the skin along the anus
  • Fistulas — Abnormal tunnels between the anus and the skin
  • Abscesses — Painful, swollen masses containing pus, typically from a bacterial infection

People with perianal HS have similar symptoms and can develop abscesses and sinus tracts (channels that form between lesions) that leak pus or blood. Studies show that up to 40 percent of people with Crohn’s disease also have perianal HS.

If you begin experiencing symptoms of IBD, let your doctor know. They may refer you to a gastroenterologist who can help. HS and IBD are both managed with steroids or biologics, such as adalimumab (Humira) and infliximab (Remicade).

Axial Spondyloarthritis

Spondyloarthritis, or spondylitis, is an inflammatory joint condition that can affect the spine, arms, and legs. One type is axial spondyloarthritis (axSpA), which involves the joints that connect the pelvis to the bottom of the spine (the sacroiliac joint). In some cases, these joints may fuse together, leading to stiffness and mobility issues.

Symptoms of axSpA include:

  • Pain in your lower back, hips, or buttocks
  • Pain, redness, warmth, and swelling in your knees, toes, ankles, heels, neck, or shoulders
  • Joint stiffness in the mornings
  • Pain at night when you’re trying to sleep
  • Loss of appetite

Axial spondyloarthritis, like HS, is triggered by an overactive immune system, which creates too much inflammation. Studies have found that people with HS are more likely to develop spondyloarthritis or axSpA than those without HS. Spondyloarthritis symptoms also tend to be worse in those with HS.

If you begin experiencing new back pain or other symptoms of spondyloarthritis while living with HS, talk to your doctor. They may refer you to a rheumatologist who can help diagnose and manage your joint pain.

Skin Cancer

People living with HS are also more likely to develop skin cancer. Doctors and researchers aren’t quite sure why HS increases this risk, but they believe it may be due to chronic inflammation in the skin. Inflammation can damage DNA in cells, raising the risk that they’ll become cancerous.

The two most common types of skin cancer are squamous cell carcinoma and basal cell carcinoma. Each is associated with its own set of symptoms to look out for.

Symptoms of squamous cell carcinoma include:

  • Discolored lumps or nodules that look like they’re under the skin
  • Lesions or spots that appear crusty or dry, like a scab
  • Elevated lesions with raised edges
  • Open sores that don’t heal on their own

Symptoms of basal cell carcinoma include:

  • Shiny nodules that look like pearls or moles
  • New scars not caused by a scratch or injury
  • Pink lesions with crusts that look like scabs

Studies show that people with HS are 4.6 times more likely to develop nonmelanoma (slow-growing) skin cancer. It appears that males with HS develop squamous cell carcinoma four times more often than females do, according to a study in the journal Dermato-Endocrinology, and that most cases (61 percent) affect the buttocks and perineal area (the skin between the genitals and anus).

When living with HS, it’s important to get regular skin checks to look for signs of squamous or basal cell carcinoma. Skin cancer and HS lesions can look very similar — your dermatologist will be able to tell the difference between them and monitor your condition.

Mental Health Conditions

Mental health conditions like depression and anxiety tend to more frequently affect those with chronic skin conditions, such as HS and psoriasis. Living with a painful, visible condition like HS is stressful and can cause emotional distress. Many people are also afraid of the stigma and social isolation that comes with having noticeable symptoms such as lesions, scars, and odor.

Studies suggest that more than 50 percent of people with HS report that the disease affects their quality of life, according to a research review in the journal Dermatology and Therapy.

Researchers have also found that depression affects people with HS more than the general population. One small study in the Journal of the German Society of Dermatology reported that 38.6 percent of people with HS experienced depression, compared to just 2.4 percent of those without HS.

Symptoms of depression typically interfere with your day-to-day life. Examples include:

  • Feeling sad, down, or depressed
  • Feeling lost or hopeless
  • Feeling ashamed or embarrassed about HS
  • Lacking motivation
  • Being easily irritated

If you begin experiencing symptoms of depression, talk to your dermatologist. They can go over your treatment plan to help you better manage HS symptoms that are contributing to your depression. Your doctor may also refer you to a mental health professional who can offer therapy and medication to help treat depression.

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is a hormonal condition caused by high levels of androgens, a sex hormone. Abnormal levels of these hormones can interfere with the menstrual cycle and cause hirsutism (abnormal hair growth) and acne.

Both PCOS and HS are caused by hormonal imbalances, and researchers believe that sex hormones play a role in HS — studies report that symptoms change with the menstrual cycle. A study in the journal Acta Dermatovenerologica Croatica focused on the possible role of androgens. Noting that HS tends to be reported as higher in women than men, the researchers found that blocking androgens in women with HS helped improve symptoms.

Studies show that people with HS are 2.14 times more likely to have PCOS than people without HS. They also share other comorbidities, including obesity and diabetes. If you have PCOS symptoms along with HS, talk with your doctor about how you can manage them. They may suggest treatment options such as hormonal birth control pills or spironolactone (Aldactone).

Metabolic Syndrome

Metabolic syndrome (MetS) is a set of conditions that interfere with metabolism, or how well your body produces energy from the food you eat. To be diagnosed with MetS, you must have at least three of these conditions:

  • High blood sugar (blood glucose) levels
  • High blood pressure
  • Extra fat around your abdomen, which increases your waistline
  • High levels of triglycerides or fats in your blood, which can raise “bad cholesterol” (low-density lipoprotein)
  • Low levels of “good cholesterol” (high-density lipoprotein)

MetS affects roughly one in three American adults, but it seems that people with HS are also at an increased risk. Doctors and researchers aren’t quite sure why, but they believe that chronic inflammation from HS may disrupt your metabolism. Uncontrolled inflammation can be a risk factor for early atherosclerosis, a type of hardening of the arteries.

One study from Denmark, published in JAMA Dermatology, found that people with HS from the general population were twice as likely to have MetS as those without HS. People with HS who were hospitalized were four times as likely to have MetS. Another study reported that people with HS were more likely to be obese and have high blood pressure and cholesterol levels than those without HS.

Many signs of MetS are found during routine doctors’ visits, so be sure to attend all your checkups. If you have any of the requirements of a MetS diagnosis, your health care provider will go over lifestyle changes and treatment options to address them.

Condition Guide

References
  1. Hidradenitis Suppurativa: Overview — American Academy of Dermatology Association
  2. What Is Inflammatory Bowel Disease (IBD)? — Centers for Disease Control and Prevention
  3. Inflammatory Bowel Disease (Overview) — Cleveland Clinic
  4. Hidradenitis Suppurativa: Causes — American Academy of Dermatology Association
  5. Review of Comorbidities of Hidradenitis Suppurativa: Implications for Daily Clinical Practice — Dermatology and Therapy
  6. Overall and Subgroup Prevalence of Crohn Disease Among Patients With Hidradenitis Suppurativa — JAMA Dermatology
  7. Crohn’s Disease — Cleveland Clinic
  8. Association of Hidradenitis Suppurativa with Crohn’s Disease — World Journal of Clinical Cases
  9. Hidradenitis Suppurativa: Diagnosis and Treatment — American Academy of Dermatology Association
  10. Treatment for Crohn’s Disease — National Institute of Diabetes and Digestive and Kidney Diseases
  11. Spondyloarthritis — American College of Rheumatology
  12. Ankylosing Spondylitis — Arthritis Foundation
  13. Chronic Inflammation — National Cancer Institute
  14. Basic Information About Skin Cancer — Centers for Disease Control and Prevention
  15. Skin Cancer Types: Squamous Cell Carcinoma Symptoms — American Academy of Dermatology Association
  16. Skin Cancer Types: Basal Cell Carcinoma Signs and Symptoms — American Academy of Dermatology Association
  17. Assessment of Overall and Specific Cancer Risks in Patients with Hidradenitis Suppurativa — JAMA Dermatology
  18. Comorbidities of Hidradenitis Suppurativa (Acne Inversa) — Dermato-Endocrinology
  19. The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study Among Dermatological Out-Patients in 13 European Countries — The Journal of Investigative Dermatology
  20. Depression Is a Frequent Co-Morbidity in Patients With Acne Inversa — Journal of the German Society of Dermatology
  21. Depression (Major Depressive Disorder) — Mayo Clinic
  22. Hidradenitis Suppurativa: How to Cope When Depression Hits — American Academy of Dermatology Association
  23. Polycystic Ovary Syndrome (PCOS) — Johns Hopkins Medicine
  24. The Role of Androgens and Estrogens in Hidradenitis Suppurativa – A Systematic Review — Acta Dermatovenerologica Croatica
  25. Hidradenitis Suppurativa Is Associated With Polycystic Ovary Syndrome: A Population-Based Analysis in the United States — The Journal of Investigative Dermatology
  26. What Is Metabolic Syndrome? — National Heart, Lung, and Blood Institute
  27. Hidradenitis Suppurativa and the Metabolic Syndrome — Clinics in Dermatology
  28. Association of Metabolic Syndrome and Hidradenitis Suppurativa — JAMA Dermatology
  29. Hidradenitis Suppurativa and Metabolic Syndrome: A Comparative Cross-Sectional Study of 3207 Patients — The British Journal of Dermatology
  30. Metabolic Syndrome — Mayo Clinic

Posted on April 24, 2023
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Zeba Faroqui, M.D. earned her medical degree from the SUNY Downstate College of Medicine. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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