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The chronic skin inflammation, recurring abscesses, and scarring that come with hidradenitis suppurativa (HS) can eventually lead to other complications. Some of them involve your skin, while others affect your overall health. Finding ways to keep your HS managed and under control can lower your risk of developing complications.
Some HS complications can be life-threatening, but being aware of their signs can help you catch and treat them as early as possible. In this article, you’ll learn about some of the most common complications of hidradenitis suppurativa, their symptoms, and their connection to HS.
Anemia is a blood disorder that occurs when you have too few red blood cells or when your red blood cells don’t function properly. There are a few different types that range from mild and easily treatable to severe and life-threatening. The most common is iron deficiency anemia, which develops when you lose a lot of blood or if you don’t get enough iron from the foods you eat.
Research suggests that people with hidradenitis suppurativa are six times more likely to have anemia than the general population. This includes several types of anemia. If you have HS, you’re over seven times more likely to have iron deficiency anemia and almost 20 times more likely to have sickle cell anemia.
Anemia doesn’t always cause symptoms, so you might not be aware you have it. However, anemia in HS can cause fatigue and other symptoms, including:
HS can lead to anemia due to chronic inflammation it causes in your body. With too much inflammation, your body struggles to produce enough red blood cells.
Often, the most effective way to treat anemia is by treating the underlying condition causing it. You can treat HS-related anemia or prevent it as a complication through proper treatment of HS to control the inflammation. Your doctor might prescribe biologics or antibiotics to lower inflammation related to HS, which would allow your body to produce more red blood cells.
Your doctor might recommend treatments specifically for your anemia too. Iron-deficiency anemia, for example, can be treated with iron supplements or by eating more iron-rich foods. Always talk to your doctor before starting a new supplement.
Cellulitis is a skin infection that can develop when bacteria gets into your skin, usually through a wound. Generally, it’s most common on the lower half of your body, but it can develop anywhere that bacteria has the opportunity to enter.
A member of myHSteam talked about their experience with cellulitis as a complication of hidradenitis suppurativa. “I’ve been diagnosed with cellulitis in my right calf along with my HS flares and the constant drainage and the smell,” they shared. “I’m afraid I may have caused the cellulitis from touching my HS, then touching my leg where I tried to shave a bit.”
According to one study, people with HS were six times more likely to develop cellulitis than the general population.
Cellulitis symptoms can appear similar to HS abscesses. Symptoms can include:
In some cases, cellulitis causes more general symptoms of an infection, such as a fever and chills. It’s important to note that pus in an HS lesion doesn’t necessarily mean the skin is infected. Pus is common in skin affected by HS.
Cellulitis can develop when bacteria gets into the damaged sweat glands and sinus tracts in skin with HS. This is why cellulitis infections tend to occur around HS bumps, which worsens symptoms.
Oral antibiotics are usually the main treatment for cellulitis because they kill the bacteria that cause the infection. Some oral antibiotics are also used to treat HS itself because they help control inflammation.
In order for antibiotics to get rid of a cellulitis infection, you must take the full course. Don’t stop taking your antibiotics just because the symptoms have cleared.
In severe cases, you might need intravenous (IV) antibiotics at a hospital to treat cellulitis from HS.
A fistula is a connection between two organs or body parts that isn’t supposed to be there. It might happen between two organs, two blood vessels, or your skin and an organ. In some cases, fistulas involve an opening or channel between the two organs or body parts, which allows substances like blood, feces, or pus to travel through them.
Perianal fistulas, or fistulas between your bowel and the skin of your anus, are particularly common in people living with HS.
Fistulas can have a wide range of symptoms depending on where they’re located. In HS, fistulas often develop around the genitals or buttocks, creating a channel between the skin and your bladder or bowel.
Fistulas like these can cause symptoms like:
It’s common for cellulitis to develop around a fistula, causing the discoloration and swelling.
Active HS in areas around your anus or genitals can involve lots of inflammation, which causes damage and tunneling through the skin and organs. Inflammation and trauma to the skin from HS can lead to fistulas forming in areas where your HS is active.
Some fistulas in HS can be treated with biologic medications for HS, while others require surgery. Medications may be able to treat your fistula by reducing inflammation in your body and treating the underlying HS.
Most perianal fistulas need surgery to close the fistula and stop the fluid leakage that comes with it. Your healthcare provider can tell you if your fistula is simple or complex and which surgical technique they’ll use. You might need several surgeries to close a complex fistula.
When a fistula is infected, antibiotics can treat the infection.
If HS isn’t kept under control well, over time it can cause damage to your lymphatic system. Your lymphatic system is a group of vessels, tissues, and lymph nodes that help balance fluid and fight infections in your skin and throughout your body.
HS often occurs around your genitals and armpits, where there are also many lymph nodes. Scarring and inflammation from HS can block lymphatic drainage, leading to:
Swelling from lymphatic system damage is called lymphedema. Lymphedema can be painful or uncomfortable, and it raises the risk for deep skin infections.
The best way to prevent or treat lymphatic damage in HS is to find an effective treatment regimen for your hidradenitis suppurativa. However, in some cases, your doctor might recommend surgery to treat lymphatic system damage. Surgery aims to improve the flow of lymph fluid. It might involve moving healthy lymph nodes to areas where nodes have been damaged or restructuring damaged lymph channels.
Like cellulitis, sepsis is another type of infection that can be a complication of HS. Sepsis is an intense and overwhelming immune system response to infection. When you have sepsis, your immune system attacks your healthy organs and tissues. Sepsis can also involve blood clots that block blood from reaching organs, leading to possible organ failure. In some cases, sepsis is potentially fatal.
Although inflammation in HS can spread throughout your body and you might get a fever in a severe case of HS, sepsis in HS is quite rare. And, interestingly, people with HS have a lower risk of dying from sepsis than people without HS. Experts believe this difference is because sepsis is overdiagnosed in people with HS.
The symptoms of sepsis depend on which part of your body sepsis affects. When sepsis stems from a blood infection in HS, you might notice:
Sepsis might occur in HS if bacteria gets into skin abscesses and makes its way into your bloodstream.
Sepsis is a medical emergency and needs treatment right away, usually in the intensive care unit (ICU). Antibiotics can treat the bacterial infection that caused sepsis, but you might also need IV fluids, medications to tighten your blood vessels, or treatments for any organ failure that sepsis causes. You might also need surgery to remove tissue damaged by sepsis.
A type of skin cancer called cutaneous squamous cell carcinoma (SCC) can be a complication of hidradenitis suppurativa. Cutaneous SCC can develop in the top layer of your skin when skin cells called squamous cells overproduce because of damage to their DNA.
Skin cancer is a very rare complication of HS, but it can develop after many years of uncontrolled inflammation damaging your skin. HS can also raise your risk for other cancers, including prostate cancer and lymphoma, compared to the general population.
It’s important to know the symptoms of skin cancer so you can recognize and treat it as early as possible, even though cutaneous SCC rarely spreads to other areas of your body. Many skin changes can be signs of skin cancer, including:
Tell your dermatologist right away if you notice any changes to your skin.
In most people, cutaneous squamous cell carcinoma develops because of exposure to ultraviolet (UV) radiation from the sun. But in people with HS, SCC can develop because of skin cell damage from chronic inflammation and weakened skin cell immunity.
You can prevent skin cancer as an HS complication by managing your HS through a personalized treatment plan.
Dermatologists usually diagnose skin cancer with a biopsy, which involves removing and examining a sample of cells from your skin under a microscope. If you have cutaneous SCC, they may decide to remove the cancer with cryosurgery (freezing it off), excision (cutting it out), or curettage and electrodesiccation (scraping and burning it).
On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.
Have you developed any complications connected with hidradenitis suppurativa? Let others know in the comments below.
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