When you’re living with hidradenitis suppurativa (HS), discomfort may be part of your daily life. However, HS symptoms can sometimes worsen significantly — the pain becomes unbearable or a lesion looks infected — such that you consider seeking immediate medical care.

In the middle of a hidradenitis suppurativa flare-up, it’s normal to wonder if you should go to the hospital emergency room (ER) — and whether the medical staff there will know how to help. More than 130,000 people with HS in the United States ended up in hospital emergency departments in 2017, according to a 2020 research letter in JAMA Dermatology.

Here’s what you need to know about going to the hospital with hidradenitis suppurativa so you can make an informed decision for your physical health, mental health, quality of life, and overall well-being.

Why Go to the Hospital With HS

People with hidradenitis suppurativa (also called acne inversa) may go to the hospital for several reasons, including pain or a suspected infection.

Members of myHSteam have gone in for both reasons. One person said, “The pain has been increasing. Crippling pain. I’m dreading the visit to the emergency room. I’m out of meds, tears, and options.”

Another member, who had been to the emergency room several times for infections, explained, “Sometimes I go in and it’s a simple numb and lance. Other times, I’ve had IV antibiotics for a few days. And a couple of times, I had surgery and antibiotics.”

In the 2020 research letter, only about 3.8 percent of people who went to the ER for HS in the U.S. ended up being admitted. The rest had their condition treated in the ER. Members of myHSteam have experienced similar outcomes. One described their experience, saying: “I went to the emergency room yesterday. They had to lance it and put in a catheter for drainage.”

For some people with hidradenitis suppurativa, going to the emergency room can feel like a lot of work for little benefit because they don’t get the medication they need for an extended period of time. One lamented, “I hate when I go to the emergency room, and they treat me and give me morphine to help with the pain, and I actually feel relief. But once I feel better, they send me home on ibuprofen or Advil. What is that gonna do? I hate that people don’t understand how painful this can get.”

Others find heading to the ER to be too much work when they are so uncomfortable and feel like they can’t think straight. “I thought about going to the emergency room last night,” one person shared, “but I had to get dressed and figure out how to get there. So I just grinned and bore it. It was rough and today is no better.”

Because going to the hospital with HS takes a lot of energy, can be expensive, and does not necessarily mean you’ll get the treatment options or medical management you need, it’s important to know what to look for before you go.

Hidradenitis Suppurativa and Pain

Per the 2020 research letter, almost 70 percent of people with HS who went to an emergency room reported severe pain. Forty percent of them gave their pain a 10 on a 1-10 pain-rating scale. That kind of pain is no joke, and if you’re experiencing it and not getting any relief, then the hospital may be the right way to go.

It’s important to note that opioids are often prescribed during ER visits for HS pain. While this is not necessarily a problem, emergency staff may not know what to do if you don’t want these medications, either due to potential side effects or because you cannot take them. In addition, taking them may raise the chances of developing an opioid addiction. However, they may be the only medications that effectively give you relief from the pain.

Researchers are currently investigating HS and pain to determine whether there might be more effective methods of pain management without the risk of addiction. Meanwhile, as mentioned by the member above, opioids may only be prescribed while you are in the hospital. If you need a long-term solution for HS pain, you will need to visit a dermatologist who understands it and knows how to help.

Should You Go to the Hospital for HS Pain?

If your pain is extreme and you cannot get relief, you should go to the hospital. Even if they don’t give you something long term, they should be able to help you get at least short-term relief and connect you to someone who can help you treat the condition afterward.

Hidradenitis Suppurativa vs. Infection

Hidradenitis suppurativa itself is not an infection, nor is it caused by one. However, HS symptoms like cysts or nodules in your armpits, inner thighs, or other locations may leave behind wounds and sinus tracts that can become infected. This can cause:

• Abscesses (collections of pus)
• Cellulitis (bacterial infections)
• Carbuncles, or furuncles (types of hair follicle infections)

This is particularly true if the wound has already been opened.

No one knows exactly how often HS wounds get infected, likely because many are successfully treated at home instead of at a doctor’s office or hospital. However, infection can occur with HS and must be treated right away when it happens. Left untreated, an infection can worsen your HS. ER staff can also help you get the wound care you need so you can recover properly.

Signs an HS Wound Has Become Infected

Symptoms of hidradenitis suppurativa overlap with some of those of other skin conditions — specifically, of a skin or hair follicle infection. This can make it hard for anyone — you or a medical professional — to determine whether you are experiencing an HS flare or an infection.

Here are some signs of infection to look for:

• A new fever, or a stubborn fever that won’t go away
• Discolored streaks on your skin starting in the infected area and traveling away from it
• Pus coming from an open wound or visible pus under the skin
• An increase in skin discoloration, warmth, swelling, or pain

If you have these indications, it’s possible that your HS has become infected and that you may need an expanded treatment plan to beat it and feel better.

Should You Go to the Hospital for an HS-Related Infection?

If you have an affected area of skin that you suspect is infected, the hospital might be the right option for you. You should go to the emergency room right away if:

• You have a spiking fever.
• The area of infection is large and/or spreading rapidly.
• You see discolored streaks leading away from the infected area.

However, if you aren’t sure whether you have an infection or if it seems to be slow-moving, you should first consult a trustworthy dermatology expert or primary care provider — if you have one. They may send you to the emergency room, but they may also be able to see you in the office to handle it there.

If you don’t have access to a good dermatologist for HS, then you may need to go to the ER anytime you suspect an infection. While not ideal, this should help you get the care you need. When in doubt, it’s better to go to the ER and have them tell you it’s not an infection than to miss one until it makes you very sick.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 39,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Are you wondering if you need to go to the hospital because of hidradenitis suppurativa? Share your experience in the comments below, or start a conversation by posting on your Activities page.