HS Comorbidities
Hidradenitis Suppurativa is not just a skin condition - it is a systemic inflammatory disease that affects multiple systems in the body.
Research consistently shows that people with HS have higher rates of inflammatory, metabolic, hormonal, cardiovascular, and mental health conditions. Understanding these connections is essential for comprehensive care and long-term health management.
Category 1
Inflammatory Conditions
HS shares the same dysregulated immune pathways as several other chronic inflammatory diseases. Patients with HS have a significantly elevated risk of developing these conditions, and the inflammation is often bidirectional.
Crohn's Disease
HS and Crohn's disease both involve dysregulation of the innate immune system and TNF-alpha overproduction. Studies show HS patients are 2-4 times more likely to have Crohn's disease than the general population, and both conditions respond to biologic therapies targeting the same inflammatory pathways.
Read the full HS and Crohn's articleUlcerative Colitis
Like Crohn's disease, ulcerative colitis is an inflammatory bowel disease that shares immune dysregulation with HS. Patients with either IBD condition should be monitored for HS, and vice versa, as the conditions frequently co-occur.
Read the full HS and Ulcerative Colitis articleRheumatoid Arthritis
Chronic systemic inflammation from HS can contribute to joint inflammation. Rheumatoid arthritis and HS share elevated levels of pro-inflammatory cytokines including TNF-alpha and IL-17, which is why some biologic treatments benefit both conditions.
Read the full HS and Rheumatoid Arthritis articleAnkylosing Spondylitis
Ankylosing spondylitis, a form of inflammatory arthritis affecting the spine, is more prevalent in HS patients than in the general population. Both conditions involve IL-17 pathway dysregulation, and patients with HS who experience back pain or stiffness should be evaluated for spondyloarthropathy.
Read the full HS and Ankylosing Spondylitis articleCategory 2
Metabolic Conditions
HS is strongly associated with metabolic dysfunction. Chronic inflammation disrupts insulin signaling and metabolic regulation, creating a cycle where metabolic conditions worsen HS and HS worsens metabolic conditions.
Type 2 Diabetes & Insulin Resistance
HS patients have approximately 2-3 times higher odds of type 2 diabetes compared to people without HS. Chronic inflammation from HS contributes to insulin resistance through inflammatory cytokines such as TNF-alpha and IL-6, which interfere with insulin signaling.
Read the full HS and Diabetes articleMetabolic Syndrome
Metabolic syndrome - a cluster of conditions including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol - is significantly more common in HS patients. The shared mechanism is chronic low-grade systemic inflammation driving metabolic dysregulation.
Read the full HS and Metabolic Syndrome articleObesity
Obesity is both a risk factor for HS and a consequence of the disease. Excess adipose tissue produces pro-inflammatory cytokines that worsen HS, while pain and mobility limitations from HS make physical activity difficult, contributing to weight gain. Weight loss has been shown to reduce HS severity in some patients.
Read the full HS and Obesity articleCategory 3
Hormonal Conditions
Androgens - male hormones present in both men and women - play a direct role in HS pathogenesis by stimulating the sebaceous and apocrine glands. Hormonal imbalances are therefore closely linked to HS activity.
Polycystic Ovary Syndrome (PCOS)
PCOS and HS share androgen excess as a common driver. Women with PCOS have elevated androgens that stimulate the same follicular structures implicated in HS. Studies suggest HS is significantly more prevalent in women with PCOS, and hormonal treatments used for PCOS may also help reduce HS flares.
Read the full HS and PCOS articleAndrogen Imbalance
Elevated androgens - including testosterone and DHEA-S - are found in a subset of HS patients regardless of gender. Androgen excess stimulates the pilosebaceous unit, contributing to follicular occlusion and the inflammatory cascade that characterizes HS lesions.
Read the full HS and Hormones articleMenopause-Related Hormone Shifts
Many women report significant changes in HS activity during perimenopause and menopause. The decline in estrogen relative to androgens can shift the hormonal balance in ways that affect HS severity, with some women experiencing improvement and others experiencing worsening.
Read the full HS and Hormones articleCategory 4
Cardiovascular Conditions
Chronic systemic inflammation is a well-established driver of cardiovascular disease. HS patients carry an elevated cardiovascular risk that is independent of traditional risk factors such as smoking and obesity.
Hypertension
High blood pressure is more prevalent in HS patients than in the general population. Systemic inflammation promotes vascular stiffness and endothelial dysfunction, both of which contribute to elevated blood pressure. HS patients should have blood pressure monitored regularly.
Read the full HS and Hypertension articleAtherosclerosis
Atherosclerosis - the buildup of plaques in arterial walls - is accelerated by chronic inflammation. The same inflammatory cytokines that drive HS lesions also promote endothelial damage and plaque formation, increasing the risk of heart attack and stroke in HS patients.
Read the full HS and Atherosclerosis articleIncreased Cardiovascular Risk
Multiple large population studies have shown that HS patients have a 30-50% higher risk of major adverse cardiovascular events (MACE) compared to the general population, even after controlling for traditional risk factors. This elevated risk is attributed to the chronic systemic inflammatory burden of HS and underscores the importance of treating HS as a whole-body disease.
Read the full HS and Cardiovascular Risk articleCategory 5
Related Skin Conditions (Follicular Occlusion Group)
HS belongs to a group of conditions collectively known as the follicular occlusion tetrad. These conditions share the same underlying mechanism: blockage of hair follicles leading to rupture, secondary infection, and chronic inflammation.
Severe Acne (Acne Conglobata)
Severe nodulocystic acne, particularly acne conglobata, shares the same follicular occlusion mechanism as HS. Patients with a history of severe acne are at higher risk for HS, and both conditions can co-exist, often requiring similar treatment approaches including isotretinoin and biologics.
Read the full HS and Acne Conglobata articlePilonidal Disease
Pilonidal cysts and sinuses in the sacrococcygeal region are part of the follicular occlusion group and co-occur with HS more frequently than chance would predict. Patients with HS who develop recurrent pilonidal disease should be evaluated for the full spectrum of follicular occlusion disorders.
Read the full HS and Pilonidal Disease articleDissecting Cellulitis of the Scalp
Also called perifolliculitis capitis abscedens et suffodiens, this chronic inflammatory scalp condition causes painful nodules, abscesses, and scarring alopecia. It shares the same pathophysiology as HS and is considered part of the same disease spectrum, sometimes occurring simultaneously.
Read the full HS and Dissecting Cellulitis articleCategory 6
Other Associated Conditions
HS affects quality of life far beyond the skin. The chronic pain, sleep disruption, and social stigma of HS contribute to a range of associated conditions that must be addressed as part of comprehensive HS care.
Sleep Apnea
Sleep apnea is more prevalent in HS patients, partly due to the association between HS and obesity, and partly because chronic pain and discomfort from HS lesions disrupt sleep architecture. Untreated sleep apnea worsens systemic inflammation, potentially exacerbating HS activity.
Read the full HS and Sleep Apnea articleThyroid Disorders (Hashimoto's Thyroiditis & Hypothyroidism)
Autoimmune thyroid conditions, including Hashimoto's thyroiditis and hypothyroidism, are reported at higher rates in HS patients. The shared immune dysregulation between HS and autoimmune thyroid disease may explain this association. Thyroid function should be evaluated in HS patients with unexplained fatigue or weight changes.
Read the full HS and Thyroid Disorders articleDepression
Depression affects up to 30% of HS patients - a rate significantly higher than the general population. Chronic pain, visible lesions, social stigma, and the unpredictable nature of HS all contribute to depressive symptoms. Depression also worsens inflammatory markers, creating a feedback loop with HS disease activity.
Read the full HS and Depression & Anxiety deep-diveAnxiety
Anxiety disorders are common in HS patients, driven by the unpredictability of flares, fear of odor or visible lesions in social situations, and the cumulative psychological burden of living with a chronic, painful, and often misunderstood condition. Addressing anxiety is a critical component of holistic HS management.
Read the full HS and Depression & Anxiety deep-diveHS and Anemia
Chronic inflammation from HS can suppress red blood cell production, leading to anemia of chronic disease. Learn the signs, how it is diagnosed, and what can be done.
Read the full HS and Anemia articleDo You Have Any of These Related Conditions?
This checklist helps identify conditions that commonly co-occur with HS. Check all that apply to you, then bring the results to your next doctor's appointment to discuss screening or monitoring.
Related Resources
Explore these pages for deeper information on specific conditions associated with HS.
Androgen excess, hormonal treatments, PCOS-HS overlap
Shared TNF-alpha pathways, perianal HS, biologic treatment
Sleep disruption, inflammation, CPAP therapy
Androgens, menstrual cycles, menopause
Metabolic pathways, insulin resistance, management
Chronic disease anemia, iron deficiency, treatment
Depression, anxiety, CBT, peer support
Safe treatments, delivery, postpartum care
Full overview of HS as a systemic disease