Last reviewed: May 2026 | Community resource — not medical advice. If you have HS, ask your dermatologist which comorbidity screenings are appropriate for your situation.
Hidradenitis Suppurativa is not just a skin disease. This statement appears in the most authoritative medical reviews of HS — including the comprehensive 2025 Lancet review — and it represents one of the most important shifts in how this condition is understood medically.
The same inflammatory signals that drive nodules, abscesses, and sinus tracts in your skin also circulate through your bloodstream, where they can quietly damage other organ systems over years. The Lancet 2025 review states plainly: “Metabolic and organic disorders are an expression of the systemic inflammation in patients with hidradenitis suppurativa and a major cause of shortened life expectancy.”
This is not intended to alarm you. Most HS patients manage their disease well and live full lives. But it does mean that managing HS comprehensively — not just treating the skin — matters for your long-term health. And it means that symptoms in other parts of your body may be connected to your HS in ways your doctors haven’t discussed with you.
This article covers every major comorbidity associated with HS: what the research shows, how each is connected to HS biologically, what symptoms to watch for, and what screening your doctors should be offering.
📚 Reference: Sabat R et al. “Hidradenitis suppurativa.” The Lancet, 2025. The Lancet
The Comorbidity Burden: How Common and How Serious?
A 2025 population-based study published in Frontiers in Medicine — the largest comorbidity analysis of its kind in HS — found that 70.99% of HS patients exhibited multimorbidity, meaning they had more than one chronic condition alongside HS. The mean disease burden was 3.19 chronic conditions per patient.
📚 Reference: Almenara-Blasco M et al. “Multimorbidity of hidradenitis suppurativa: a cross-sectional population-based study.” Frontiers in Medicine, 2025. Frontiers
This is not a coincidence or bad luck clustering of unrelated conditions. Most HS comorbidities share a root cause with HS itself: chronic systemic inflammation, insulin resistance, immune dysregulation, and in some cases shared genetic predisposition. Treating HS more effectively may reduce the risk of some comorbidities developing or worsening — which is one of the strongest arguments for aggressive early treatment.
1. Metabolic Syndrome
What it is
Metabolic syndrome is a cluster of conditions occurring together that significantly increase the risk of heart disease, stroke, and type 2 diabetes. The five components are: central obesity (excess abdominal fat), high blood pressure, high blood sugar, high triglycerides, and low HDL (“good”) cholesterol. Having three or more of these constitutes metabolic syndrome.
The HS connection
A systematic review and meta-analysis found that adults with HS have approximately twice the odds of metabolic syndrome compared to the general population (adjusted OR 2.19, 95% CI 1.70–2.81). This association held even after adjusting for age, sex, and other cardiovascular risk factors.
The biological link is compelling: HS drives chronically elevated pro-inflammatory cytokines including TNF-α, IL-1β, IL-6, and IL-17A — the same cytokines that are key mediators in the pathogenesis of insulin resistance and metabolic syndrome. It is a bidirectional relationship: obesity and insulin resistance worsen HS, and HS inflammation may in turn worsen metabolic dysfunction.
Insulin resistance specifically has been observed in up to 50% of HS patients — far higher than the general population.
What to monitor
- Annual fasting blood glucose and HbA1c (diabetes markers)
- Fasting lipid panel (cholesterol, triglycerides, HDL)
- Blood pressure at every appointment
- Waist circumference
- BMI
📚 Reference: “Hidradenitis suppurativa and metabolic syndrome: systematic review and adjusted meta-analysis.” PubMed. PubMed
2. Cardiovascular Disease
What it is
Cardiovascular disease includes heart attack (myocardial infarction), stroke, heart failure, peripheral artery disease, and other conditions affecting the heart and blood vessels.
The HS connection — and the numbers are striking
A large 2025 retrospective cohort study published in the Journal of Clinical Medicine — using the TriNetX database of global electronic health records — compared HS patients to matched healthy controls after adjusting for cardiovascular risk factors. The findings:
- 2.06 times the risk of myocardial infarction (heart attack)
- 1.62 times the risk of ischaemic stroke
- 2.21 times the risk of heart failure
- 1.95 times the risk of major adverse cardiovascular events (MACEs)
- 2.57 times the risk of all-cause mortality
Even compared to psoriasis patients — another inflammatory skin condition with known cardiovascular risk — HS patients had significantly higher cardiovascular risk. This suggests the elevated risk is not simply due to shared risk factors like obesity and smoking, but reflects something specific about HS inflammation.
A separate Swedish study found that HS patients had a shortened life expectancy of approximately 5 years compared to matched controls without HS — attributed primarily to cardiovascular disease and related metabolic complications.
📚 Reference: Rohan TZ et al. “Hidradenitis Suppurativa Is Associated with an Increased Risk of Adverse Cardiac Events and All-Cause Mortality.” Journal of Clinical Medicine, 2025. PMC
What to monitor
- Blood pressure
- Fasting glucose and HbA1c
- Lipid panel
- Smoking cessation (smoking dramatically compounds cardiovascular risk in HS)
- Cardiovascular risk score assessment (e.g., Framingham risk score) from age 30 or at diagnosis
- Cardiology referral if multiple risk factors are present
3. Obesity
The bidirectional relationship
Obesity and HS are deeply intertwined in both directions. HS is more common and more severe in people with higher BMI — excess weight increases friction in HS-prone areas, contributes to elevated androgens, and amplifies systemic inflammation. But HS also makes physical activity painful and avoidant, creating a cycle where the disease itself contributes to weight gain.
A cross-sectional national study published in PLOS ONE in 2025 on metabolic syndrome comorbidities in HS outpatient visits confirmed obesity as among the most consistently associated comorbidities across multiple populations.
What matters clinically
Weight loss — even modest amounts — has been shown to reduce HS disease severity in patients with obesity. This is not a judgment about body size but a documented therapeutic opportunity: reducing inflammatory load through weight management can reduce flare frequency and may improve response to biologics (which show reduced efficacy at higher BMI, as discussed in our Humira article).
Referral to a dietitian experienced in inflammatory conditions, and discussion of medically supervised weight management options, is appropriate as part of comprehensive HS care.
4. Type 2 Diabetes
The HS connection
Type 2 diabetes is independently associated with HS — not just as a component of metabolic syndrome but as a standalone comorbidity. The shared mechanisms are insulin resistance and chronic inflammation; each drives the other.
Patients with HS should be screened regularly with fasting glucose and HbA1c. Current HS management guidelines explicitly include diabetes screening as a core component of HS monitoring.
Of note: metformin — one of the most commonly prescribed diabetes medications — also has anti-inflammatory properties and has been studied as an adjunct treatment in HS, with some evidence of benefit particularly in patients with PCOS and insulin resistance. The 2025 North American HS pregnancy guidelines (JAAD) included a strong recommendation for metformin use in appropriate HS patients.
5. Polycystic Ovary Syndrome (PCOS)
What it is
PCOS is a hormonal disorder affecting women of reproductive age, characterised by irregular periods, elevated androgens, and often polycystic ovaries. It is associated with insulin resistance, obesity, and metabolic syndrome.
The HS connection
The overlap between HS and PCOS is biologically logical and clinically significant. Both conditions involve elevated androgens, insulin resistance, and chronic inflammation. Research consistently finds higher rates of PCOS in women with HS compared to the general female population.
Androgen excess — which drives HS flares — is a core feature of PCOS. Women who notice their HS worsening around their menstrual cycle, particularly in the follicular phase (first week of bleeding), often have an androgen-mediated component that hormonal therapies (spironolactone, combined oral contraceptives) can address.
If you are a woman with HS and have irregular periods, excess body hair, weight concentrated in the abdomen, or difficulty conceiving, mention this to your dermatologist — a referral to an endocrinologist or gynaecologist may be appropriate.
6. Inflammatory Bowel Disease (IBD): Crohn’s Disease and Ulcerative Colitis
The HS connection — bidirectional
The relationship between HS and inflammatory bowel disease is one of the most well-characterised in the literature. Both conditions involve immune dysregulation, abnormal responses to bacteria (in skin microbiome for HS, gut microbiome for IBD), and shared inflammatory pathways.
A large study published in PMC found that HS was associated with a 36% increased risk of developing any IBD within 5 years of diagnosis — with the highest risk for Crohn’s disease (HR 2.501) followed by ulcerative colitis (HR 1.722). Critically, the relationship is bidirectional: patients with IBD also have a significantly elevated risk of developing HS.
The HS-Crohn’s connection is particularly close. Both share tunnel/fistula formation as a feature. Both are worsened by smoking. Both involve abnormal immune responses to microbial colonisation. HS around the perianal region can be genuinely difficult to distinguish from cutaneous Crohn’s disease — which requires specialist input to differentiate.
📚 Reference: “Bidirectional Risk Association Between Hidradenitis Suppurativa and Inflammatory Bowel Disease.” PMC. PMC
What to watch for
Symptoms that should prompt evaluation for IBD in an HS patient:
- Chronic diarrhoea (lasting more than 4 weeks) or alternating constipation and diarrhoea
- Rectal bleeding
- Abdominal cramping, especially after eating
- Unexplained weight loss
- Fatigue disproportionate to HS disease activity
- Perianal fistulas or abscesses (these can be HS, cutaneous Crohn’s, or both)
If you have perianal HS and any of these symptoms, ask for a gastroenterology referral.
7. Psoriasis
The shared inflammatory architecture
Psoriasis and HS share important immunological features — both involve dysregulated TNF-α and IL-17 pathways, both are associated with metabolic syndrome and cardiovascular disease, and both respond to some of the same biologics (including secukinumab, which is approved for both).
A systematic review and meta-analysis published in Frontiers in Immunology found that people with HS had a 2.67-fold higher risk of psoriasis — a highly significant association that held in sensitivity analyses.
Having both conditions simultaneously significantly compounds quality of life impairment and requires careful treatment selection, since some therapies appropriate for one condition may be suboptimal for the other.
📚 Reference: “Risk of psoriasis in people with hidradenitis suppurativa: a systematic review and meta-analysis.” Frontiers in Immunology, 2022. PMC
8. Spondyloarthritis (Inflammatory Joint Disease)
What it is
Spondyloarthritis encompasses a group of inflammatory joint conditions including ankylosing spondylitis (AS), psoriatic arthritis, and peripheral arthritis. These are distinct from osteoarthritis — they are immune-mediated inflammatory conditions.
The HS connection
HS is associated with inflammatory arthritis, particularly axial spondyloarthritis (affecting the spine and sacroiliac joints). The shared mechanism involves the IL-17 pathway, which is overactive in both conditions.
Symptoms of inflammatory arthritis that should be reported:
- Morning stiffness in the back or joints lasting more than 30 minutes
- Pain that is worse at rest and better with movement (the opposite of mechanical joint pain)
- Buttock pain alternating between sides (classic sacroiliitis symptom)
- Peripheral joint swelling (knees, ankles, wrists)
Inflammatory arthritis is often undertreated in HS patients because pain in the joints is attributed to HS-related movement restrictions rather than a separate inflammatory condition. If you have persistent joint symptoms, ask your dermatologist whether a rheumatology referral is appropriate.
9. Depression and Anxiety
The scale of the mental health burden
As covered in detail in our HS and Mental Health article, a landmark study published in JAMA Dermatology in 2025, analysing more than 10,000 Danish HS patients, found:
- HS patients were 69% more likely to develop new-onset depression compared to the general population
- HS patients were 48% more likely to develop anxiety
Depression and anxiety in HS are not “just” psychological complications — they are linked to the same inflammatory mechanisms driving the skin disease. Pro-inflammatory cytokines (TNF-α, IL-1β, IL-6) elevated in HS are also implicated in the neurobiology of depression. This means that treating HS inflammation more effectively may also reduce psychiatric symptoms — and that addressing depression is part of treating HS comprehensively.
The Lancet 2025 review explicitly identifies HS as having “higher risk of cardiovascular death and suicide risk” — a serious statement that underlines the imperative to screen and treat mental health conditions in HS patients systematically, not as an afterthought.
10. Thyroid Disease
The HS connection
Thyroid abnormalities — particularly hypothyroidism — have been associated with HS, with the relationship notably amplified in patients who smoke. The biological mechanism is not fully established, but shared immune dysregulation pathways are implicated.
Thyroid function testing (TSH, free T4) should be part of routine metabolic screening in HS patients, particularly those with symptoms of thyroid dysfunction (fatigue, weight changes, hair loss, cold intolerance, brain fog).
11. Squamous Cell Carcinoma (SCC) and Cancer Risk
An important but rare complication
One of the most serious comorbidities associated with severe, longstanding HS is the development of cutaneous squamous cell carcinoma (SCC) within the HS lesions themselves. This is a well-recognised but relatively uncommon complication, predominantly seen in:
- Men more often than women
- Caucasian patients more than other groups
- Patients with severe gluteal or perianal HS of more than 25 years’ duration
- Smokers
The mechanism involves chronic inflammation in the same skin region over decades gradually transforming into malignant change — similar to how chronic wounds can develop Marjolin’s ulcers.
A systematic review and meta-analysis published in Dermatology and Therapy in 2026, covering 624,721 HS patients, found that overall HS patients have a higher cancer risk compared to the general population, with the most consistently elevated risks for haematological malignancies (lymphoma) and, specifically in some studies, squamous cell carcinoma.
📚 Reference: “Risk of Cancer in Patients with Hidradenitis Suppurativa: Systematic Review and Meta-analysis.” Dermatology and Therapy, 2026. Springer
Warning signs in chronic HS lesions
Any change in a longstanding HS lesion should be evaluated urgently:
- A wound or lesion that suddenly starts growing rapidly
- Change in the appearance of the tissue — new raised, nodular, or ulcerating areas within a previously stable scar
- A lesion that bleeds easily or doesn’t heal as expected
- New lumps or enlarged lymph nodes near a chronic HS site
These changes require urgent dermatology review — biopsy and histological examination is needed to rule out malignant transformation.
12. Pilonidal Disease
The connection
Pilonidal disease — cysts and sinuses in the natal cleft (the crease between the buttocks, near the base of the spine) — is associated with HS and often confused with it. Both involve follicular occlusion, inflammation, and sinus tract formation. They can occur simultaneously in the same patient, or pilonidal disease may be an extension of HS to this anatomical region.
If you have recurrent painful lesions specifically in the natal cleft or tailbone area, specifically mention both conditions to your surgeon or dermatologist.
13. Down Syndrome
An important but often overlooked connection: HS occurs at significantly higher rates in people with Down syndrome (trisomy 21). Medical guidance from UAMS specifically recommends that any patient with Down syndrome presenting with severe acne should be “reverse screened” — examined for HS in skin folds. Healthcare providers treating people with Down syndrome should be aware of this association.
What All of This Means for Your Care
HS requires a whole-body approach
The Lancet 2025 review states that optimal HS care “requires interdisciplinary collaboration and should result in personalised comprehensive care strategies” — explicitly including screening and management of metabolic comorbidities alongside skin-targeted treatment.
In practice, this means:
- Your dermatologist should be asking about cardiovascular risk factors, joint symptoms, bowel symptoms, and mental health — not just your lesions
- You should have annual blood tests including fasting glucose, HbA1c, and a lipid panel
- You should have your blood pressure checked at every appointment
- If you have perianal HS, you should be evaluated for Crohn’s disease if you have any bowel symptoms
- Your HS treatment plan should be made with awareness of your other conditions — some biologics used for HS also treat other comorbidities (secukinumab for both HS and psoriatic arthritis; adalimumab for both HS and Crohn’s)
Screening recommendations at a glance
| Comorbidity | Recommended screening | Frequency |
|---|---|---|
| Metabolic syndrome | Fasting glucose, HbA1c, lipid panel, BP, waist circumference | Annually |
| Type 2 diabetes | Fasting glucose, HbA1c | Annually |
| Cardiovascular disease | Lipid panel, BP, cardiovascular risk score | Annually |
| PCOS (women) | Clinical assessment, menstrual history, androgens if indicated | At diagnosis and as needed |
| IBD | Bowel symptoms review, gastroenterology referral if symptomatic | At every appointment |
| Psoriasis | Skin examination | Ongoing |
| Inflammatory arthritis | Joint symptom review | At every appointment |
| Depression/anxiety | Mental health screen (PHQ-9, GAD-7) | Annually minimum |
| Thyroid disease | TSH | At diagnosis, then as indicated |
| Skin malignancy (severe/longstanding HS) | Clinical examination of chronic lesions | Ongoing; biopsy any suspicious change |
Talking to your doctor about comorbidities
At your next dermatology appointment, consider saying:
“I’ve read that HS is associated with several systemic conditions including metabolic syndrome and cardiovascular disease. Have I been screened for these? Is there anything I should be having checked that I’m not currently?”
This is a legitimate clinical question that any informed HS dermatologist should welcome.
The HS Warriors Community
Living with multiple conditions simultaneously is one of the most challenging aspects of HS — and one of the most commonly discussed in our community. If you are navigating a comorbidity diagnosis alongside HS, or wondering whether your other symptoms might be connected, you are not alone.
👉 Browse community discussions 👉 Medical treatment discussions 👉 Mental health and emotional support 👉 Find a dermatologist experienced in HS 👉 Join HS Warriors — free and anonymous
This article is for informational purposes only and does not constitute medical advice. All screening and treatment decisions should be made with a qualified healthcare provider who knows your full medical history.
Sources & Further Reading:
- Sabat R et al. “Hidradenitis suppurativa.” The Lancet, 2025. The Lancet
- Almenara-Blasco M et al. “Multimorbidity of HS: population-based study.” Frontiers in Medicine, 2025. Frontiers
- Rohan TZ et al. “HS and Increased Risk of Adverse Cardiac Events and All-Cause Mortality.” JCM, 2025. PMC
- “HS Is Associated with Increased Risk of Cardiovascular Disease.” PMC, 2025. PMC
- “Bidirectional Risk Association Between HS and Inflammatory Bowel Disease.” PMC. PMC
- “Risk of psoriasis in people with HS: systematic review and meta-analysis.” Frontiers in Immunology, 2022. PMC
- “Risk of Cancer in HS Patients: Systematic Review and Meta-analysis.” Dermatology and Therapy, 2026. Springer
- “HS and metabolic syndrome: systematic review and adjusted meta-analysis.” PubMed
- “Comorbidities in Hidradenitis Suppurativa.” Practical Dermatology, March 2025. Practical Dermatology
- “Chronic companions: Metabolic syndrome comorbidities in HS outpatient visits.” PLOS ONE, 2025. PMC
- American Academy of Dermatology. HS Clinical Guidelines. aad.org
- HS Foundation. Resources and provider directory. hs-foundation.org