Hidradenitis suppurativa (HS) is a chronic inflammatory HS skin disease that most people have never heard of – yet it affects roughly 1% of the global population and is far more damaging to long-term health than its name suggests. A landmark 2025 review published in The Lancet02475-9/fulltext) confirmed that hidradenitis suppurativa complications extend well beyond painful skin lesions, identifying a wide spectrum of systemic risks that touch the heart, gut, joints, mind, and even cancer risk. For patients, that finding carries enormous weight. It means that managing HS is not just about treating the skin.
Hidradenitis suppurativa (also called acne inversa) is a condition in which deep, painful lumps, abscesses, and pus-draining tunnels form repeatedly in body folds – the armpits, groin, inner thighs, and buttocks. These lesions are caused by inflammation around the hair follicle, not by poor hygiene or a contagious infection. Over time, the tunnels cause permanent scarring. The disease is characterized by painful, deep-seated nodules, abscesses, and draining tunnels in the skin of axillary, inguinal, genitoanal, or inframammary areas.
What makes HS particularly dangerous is the long gap between its first appearance and a correct diagnosis. The average delay between onset of symptoms and diagnosis is 10 years, during which patients consult with more than three different specialties and receive more than three misdiagnoses. Every year without proper treatment is a year during which the disease’s systemic effects are allowed to accumulate unchecked.
What Organs Are Affected by Hidradenitis Suppurativa?
The short answer: many. In addition to its high cutaneous symptom burden, hidradenitis suppurativa is linked to several comorbidities, including metabolic, cardiovascular, musculoskeletal, gastrointestinal, and mood disorders. This is not a coincidence. The inflammatory signals driving skin lesions in HS also circulate through the bloodstream, where they can damage other organ systems over time. Metabolic and organic disorders are an expression of the systemic inflammation in patients with hidradenitis suppurativa and a major cause of shortened life expectancy.
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The scale of this comorbidity burden is striking. Among patients with HS, 70.99% exhibited multimorbidity, with a mean disease burden of 3.19 chronic conditions. That figure comes from a 2025 population-based study published in Frontiers in Medicine, which analyzed over 1,000 HS patients in Spain. In that same cohort, the most frequent chronic comorbidities were disorders of lipid metabolism (27.8%), hypertension (19.7%), and anxiety disorders (18.7%).
HS represents the prototype for the potential link between integumentary (skin) and systemic diseases, and is associated with a higher overall comorbidity burden than even psoriasis – and that burden directly influences mortality risk. In other words, having HS does not just make life harder; it can make it shorter.
Can Hidradenitis Suppurativa Cause Serious Health Problems? The Evidence on Life Expectancy
Yes. The mortality data is sobering. A Finnish study showed that patients with hidradenitis suppurativa experience a substantially reduced life expectancy of around 15 years, mainly due to sequelae of concomitant disorders, such as ischaemic heart diseases, cerebrovascular diseases, and neoplasms. The Finnish registry study, published in the British Journal of Dermatology by researchers at the University of Oulu, examined death records over nearly three decades and drew a clear line between the disease’s systemic inflammation and premature death.
A separate Finnish national registry study cited in the Journal of Clinical and Aesthetic Dermatology found more detail: individuals with HS experienced a shortened lifespan, with the mean age at death being 60.5 years, compared to a mean of 71.1 years for patients with psoriasis and 75.2 years for controls. That gap – almost 15 years of life – is directly tied to the systemic effects of hidradenitis suppurativa on the body, not the skin disease alone.
Because metabolic and organic disorders are an expression of systemic inflammation in patients with HS, care should include direct comorbidity-targeting treatment alongside psychological support and lifestyle changes. Yet despite the severity of this picture, patients with hidradenitis suppurativa are often not even screened for comorbidities.
The Cardiovascular Connection
Heart disease is one of the most pressing hidradenitis suppurativa systemic risks identified by researchers to date. Individuals with HS exhibit a higher prevalence of cardiovascular risk factors, including obesity, diabetes mellitus, hypertension, and dyslipidemia, positioning those with HS at an elevated risk of cardiovascular disease (CVD).
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A systematic review and meta-analysis published in the British Journal of Dermatology analyzed the cardiovascular profile of HS patients in detail. Significant associations were found between HS and obesity, active smoking, a history of smoking, high triglycerides, low HDL cholesterol, diabetes, and metabolic syndrome. These are all classical building blocks of heart disease. The question researchers are still working to answer is how much of that elevated risk comes from these shared risk factors versus the chronic inflammation itself.
The Journal of Clinical and Aesthetic Dermatology notes that despite limited research on cardiovascular risk in patients with HS, emerging evidence indicates an increased risk of adverse cardiovascular outcomes in this population, consistent with data from other chronic inflammatory diseases indicating that the inflammatory nature of the disease itself is elevating cardiovascular events. A large 2024 propensity-matched cohort study drew that line more sharply, finding that 47 cardiovascular diseases are associated with an increased risk of onset in HS patients, with the highest hazard ratios found for heart failure, myocardial infarction, and acute embolism with deep vein thrombosis of the lower extremity.
Emerging genetic research adds another layer. A 2024 Mendelian randomization study – a method that uses genetic data to test for causal relationships rather than mere associations – found that HS was linked to a higher risk of coronary artery disease and showed positive correlations between HS and myocardial infarction and coronary atherosclerosis. This type of study design is more resistant to confounding factors than observational data, making these findings especially noteworthy, though the authors acknowledge more research is needed to confirm causality.
For patients managing HS inflammation, regular blood pressure checks, lipid panels, and blood glucose tests are practical steps that can catch cardiovascular risk factors early.
Metabolic Syndrome and Diabetes
Metabolic syndrome is a cluster of conditions – including central obesity, high blood sugar, elevated triglycerides, low HDL, and high blood pressure – that together raise the risk of heart disease and type 2 diabetes. The connection between HS and metabolic syndrome is one of the most consistently replicated findings in dermatology hidradenitis research.
Metabolic syndrome has been reported in up to 65% of individuals with HS, versus an estimated 10-25% in the general population. That is a dramatic difference. Obesity in particular is strongly linked to HS, potentially contributing to its pathogenesis through mechanical stress in skin folds and chronic systemic inflammation, while lipid abnormalities and insulin resistance may also exacerbate disease severity and progression.
On the question of diabetes specifically, a systematic review and meta-analysis published in the British Journal of Dermatology found that HS was associated with a 1.69-fold increased odds of diabetes, though the absolute risk difference was small and authors noted this relationship deserves monitoring by treating clinicians. The elevated risk is real, but the practical conclusion is routine glucose monitoring – not alarm.
A 2021 cross-sectional study measuring carotid intima-media thickness (IMT) – a marker of how much plaque has accumulated in the artery walls – found that patients with severe HS with active tobacco consumption, long disease duration, and metabolic comorbidities, especially abnormal glucose values or diabetes mellitus, represent a subset of patients with particularly elevated cardiovascular risk. Tobacco use is a significant modifier here. Quitting smoking reduces both HS flare frequency and the downstream cardiovascular risk that comes with it.
What Diseases Are Associated with Hidradenitis Suppurativa? The Gut Connection
One of the most clinically significant hidradenitis suppurativa health risks involves the gut. HS shares remarkable biological overlap with inflammatory bowel disease (IBD) – the umbrella term for Crohn’s disease and ulcerative colitis (UC), conditions in which the immune system attacks the digestive tract.
A 2019 systematic review and meta-analysis published in JAMA Dermatology analyzed over 93,000 unique HS patients and found that patients with HS had 2.12-fold increased odds for Crohn’s disease and 1.51-fold increased odds for ulcerative colitis. One cohort study in that same analysis found an even steeper association. One cohort study found a 5.6-fold increased risk of inflammatory bowel disease in patients with HS, and the authors note that gastrointestinal symptoms such as recurrent abdominal pain and chronic diarrhea should not be overlooked in patients with HS.
The association between Crohn’s disease and HS is supported by clinical and histological similarities, including sinus tract development, granulomatous inflammation, and scarring, as well as intersections in pathogenesis through shared genetic loci, immune dysregulation mechanisms, and microbiome changes. This is not just a statistical overlap. Both conditions appear to share common immune pathways, and both can respond to the same biologic treatments.
The practical implication for patients is clear. When patients with HS present with recurrent abdominal pain, chronic diarrhea, bloody stool, and body weight loss, consultation with a gastroenterologist should be sought. These symptoms warrant investigation, not dismissal as an unrelated complaint. People managing HS skin disease should mention any persistent gut symptoms to their doctor directly.
For more on how autoimmune conditions like HS can affect multiple body systems, including the skin, joints, and gut, check out this related article from The Hearty Soul.
Mental Health: One of the Most Overlooked Hidradenitis Suppurativa Complications
The emotional burden of living with HS is severe – and it goes beyond what anyone might expect from a skin condition. Chronic pain, the location of lesions in intimate areas, visible scarring, and the odor from draining wounds all combine to create a profound psychological toll.
A comprehensive meta-analysis published in the Journal of the American Academy of Dermatology quantified this burden clearly: the prevalences of depression (26.5% vs 6.6%) and anxiety (18.1% vs 7.1%) were higher in persons with versus without HS, with patients having 2.54-fold higher odds of depression and 2.00-fold higher odds of anxiety.
Among all dermatological diseases, the life impact of HS ranks especially high. Research published in the Journal of the American Academy of Dermatology in 2024 found that among dermatologic diseases, HS may have the most significant life impact, with the prevalence of depression in HS populations as high as 30%, and new-onset generalized anxiety disorder occurring at approximately 6 per 100 person-years.
The most serious mental health risk associated with HS is suicide. A study using the Danish national registries found that the increased risk of completed suicide in HS patients is not solely explained by lifestyle and demographic differences and highlights the profound impact HS has on the lives of patients with this often devastating disease. More recent data, from a propensity-matched study of 55,805 HS patients published in the Journal of the American Academy of Dermatology01264-7/fulltext), showed that patients with HS had higher odds of developing suicidal ideation and suicide attempt compared to healthy controls, even in patients with no previous psychiatric history.
These findings are a clinical signal. Dermatologists, primary care physicians, and any provider seeing an HS patient should routinely screen for depression, anxiety, and suicidality as part of standard care. Patients themselves should feel no shame in raising these struggles – they are a documented, biological consequence of living with chronic pain and social stigma.
Lymphedema and Restricted Movement
The areas of the body most affected by HS – the armpits, groin, and genitals – also happen to contain dense networks of lymph nodes. Lymph nodes are small glands that filter fluid and help the immune system do its job. When HS scars and tunnels form repeatedly in these regions, the lymphatic drainage system can be disrupted.
Hidradenitis suppurativa recurrence may result in chronic pain, limb contractures, and impaired mobility from abscesses, tunnels, and scarring, while lymphatic obstruction may cause peripheral lymphedema. Lymphedema means the fluid the lymph system normally carries backs up and causes swelling – often in the arms, legs, or genitals. This swelling can be persistent and painful, and in severe cases it limits mobility significantly.
Stasis of lymphatic drainage in the affected skin regions also creates a secondary risk. Stasis of lymphatic drainage, a known complication of HS, is a contributing factor that prevents the normal flow of immune cells into the lymphedematous region, thereby increasing the risk for malignant transformation. This brings us directly to the most severe long-term complication of all.
The Cancer Risk: Squamous Cell Carcinoma
Among all the long-term complications of hidradenitis suppurativa, the development of cutaneous squamous cell carcinoma (cSCC) – a form of skin cancer – is considered the most severe. It is uncommon, but its consequences can be fatal.
The transformation of chronic HS to squamous cell carcinoma is often considered the most severe complication of the disease. A systematic review published in the journal Cancers analyzed 138 cases and found that the majority of patients were male (81.6%), White (83.3%), and smokers, with most having gluteal or perianal HS at Hurley stage 3, and the mean time from HS diagnosis to the development of squamous cell carcinoma was 24.7 years.
How does this cancer develop? Researchers point to a concept called the “immunocompromised cutaneous district.” The development of squamous cell carcinoma in longstanding HS is a condition of an immunocompromised district – an area of diseased or injured skin where local immune control has been altered, permitting the development of a dysimmune reaction or tumor confined to that site. In plain terms: decades of chronic inflammation and scarring leave the affected skin unable to properly suppress abnormal cell growth.
The development of SCC is most commonly associated with White men who smoke and have severe gluteal or perianal lesions lasting more than 25 years. Beyond SCC, HS patients also have an increased risk of developing other cancers, including prostate, oral, pharyngeal, and colorectal cancers, as well as lymphomas. Any patient with long-standing, severe HS lesions – especially in the perianal and gluteal region – should be monitored by a dermatologist for suspicious changes in existing sores.
Chronic inflammation’s long-term effects also include anemia, hyperproteinemia (excess protein in the blood), amyloidosis (an abnormal protein buildup in organs), and axial and peripheral arthropathy (joint disease), while superimposed infections may result in systemic illness. Each of these represents a distinct bodily system being pulled into the HS disease process over time.
Read More: 8 Autoimmune Symptoms You Could Be Overlooking
What This Means for You
The research across dozens of population-based studies and meta-analyses builds one clear conclusion: hidradenitis suppurativa is a systemic disease that happens to start in the skin. The hidradenitis suppurativa link to other diseases – from heart disease and diabetes to inflammatory bowel disease, depression, and cancer – is no longer speculative. It is documented, quantified, and repeated across countries and populations. What remains frustratingly inconsistent is the medical response. The US and Canadian HS Foundations have provided levels of evidence and strength of screening recommendations to support early recognition and treatment of comorbid conditions with the goal of improving long-term health outcomes for patients with HS. Yet in practice, many patients are still treated only for their skin.
If you have been diagnosed with HS, ask your doctor for a full metabolic workup – blood pressure, fasting glucose, HbA1c, and a lipid panel. Ask about mental health screening. Report any digestive symptoms like recurring abdominal pain, chronic diarrhea, or unexplained weight loss. If your lesions have been severe and long-standing, request dermatological monitoring for skin changes that could signal malignant transformation. Hidradenitis suppurativa is a complex condition with numerous comorbidities requiring an interprofessional approach, and while the disorder is primarily a dermatologic concern, individuals may first seek care from various healthcare providers across specialties. A dermatologist who treats only the lesions, without considering the whole body, is not seeing the full picture. You deserve a team that does.
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This article is intended for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment of any medical condition.
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Medical Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice because of something you have read here.