HS carries the highest Dermatology Life Quality Index (DLQI) score of any skin condition, with an average score of 18 out of 30. Depression and anxiety are significantly more common in people with HS than in the general population, and the relationship is bidirectional: HS causes psychological distress, and psychological distress can worsen HS through stress-mediated inflammation. This guide explains the connection and what to do about it.
The Numbers
Multiple studies have documented elevated rates of depression and anxiety in HS patients. A 2025 systematic review confirmed that chronic skin disorders, particularly those involving visible or malodorous lesions, have a profound impact on mental health. The specific challenges of HS, including pain, drainage, odor, fatigue, and social isolation, create a particularly heavy psychological burden.
A 2025 qualitative study involving 40 in-depth interviews with HS patients documented the cumulative burden of the condition: participants described how HS affected their ability to work, maintain relationships, engage in physical activity, and feel comfortable in their own bodies. The psychological impact was described as inseparable from the physical disease.
Why HS Causes Depression and Anxiety
The psychological impact of HS is not simply a reaction to having a skin condition. Several mechanisms contribute. Chronic pain is itself a major driver of depression and anxiety. The unpredictability of flares creates chronic stress and hypervigilance. Social isolation from avoiding activities due to pain, drainage, or embarrassment reduces protective social connections. The diagnostic delay (averaging 7 to 10 years) means many patients spend years without answers, feeling dismissed by the medical system.
Evidence-Based Strategies
Addressing the mental health component of HS is as important as treating the physical disease. Evidence-based approaches include cognitive behavioral therapy (CBT), which has strong evidence for both chronic pain and depression; mindfulness-based stress reduction (MBSR), which has been shown to reduce pain catastrophizing and improve quality of life in chronic pain conditions; peer support through HS patient communities, which reduces isolation and provides practical knowledge; and medication when appropriate, including antidepressants that also have pain-modulating effects.
Talking to Your Doctor About Mental Health
Mental health should be a routine part of HS care conversations. If your dermatologist has not asked about your mental health, bring it up. You might say: "The psychological impact of HS has been significant for me. I would like to discuss options for support." A good HS care team will take this seriously and can provide referrals to psychologists, therapists, or psychiatrists with experience in chronic illness.
Finding Community
One of the most powerful things you can do for your mental health with HS is connect with others who understand. HS-specific online communities exist on multiple platforms and provide a space where patients can share experiences, ask questions, and feel genuinely understood. Searching for HS patient groups on social media platforms or asking your dermatologist about local support networks can help you find community. Knowing you are not alone in this condition is not a small thing.