Hidradenitis Suppurativa: Comorbidities

Hidradenitis suppurativa (HS) is more than just a chronic skin condition. That was the key message delivered by Dr Alice Gottlieb in her insightful session, “Co-morbidities of Hidradenitis Suppurativa.” This session served as a sharp reminder that HS must be approached as a systemic disease with wide-ranging implications.

“HS is linked to systemic inflammation and multiple comorbidities,” Gottlieb emphasized. “Early recognition and management of comorbidities improve patient outcomes.”

Dr Gottlieb outlined a broad spectrum of HS-associated conditions, spanning nearly every system. These include:

• Metabolic and cardiovascular: Increased risk of metabolic syndrome, type 2 diabetes, dyslipidemia, hypertension, myocardial infarction, and stroke.
• Endocrine: Nearly double the rate of polycystic ovary syndrome, along with thyroid dysfunction and insulin resistance.
• Gastrointestinal and autoimmune: Strong associations with Crohn’s disease, arthritis, and shared inflammatory pathways with psoriasis.
• Psychiatric: Depression (up to 40%), anxiety disorders, substance use, and increased risk of suicidal ideation.

Patients with HS also face increased risks of recurrent infections, including cellulitis and sepsis in severe cases. Of particular concern is squamous cell carcinoma, especially in chronic gluteal and perianal lesions.

Dr Gottlieb also walked attendees through the “follicular occlusion tetrad:”

• Acne conglobata
• Pilonidal sinus
• Dissecting cellulitis of the scalp
• HS itself

“I see more eczema in HS than I see psoriasis in HS.”

Although rare, Dr Gottlieb discussed several inflammatory syndromes, such as PASH (pseudoangiomatous stromal hyperplasia), PAPASH (pyoderma gangrenosum, acne, psoriasis, arthritis, and HS) SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis), that overlap with HS and illustrate the disease’s deeper immunologic roots. “IL-1 and IL-17 may be therapeutic targets” in these patients, she noted.

Dr Gottlieb stressed the need for a multidisciplinary care model and routine screening for psychiatric symptoms, cardiovascular risk, and autoimmune diseases, as well as malignancy surveillance in chronic lesions. “Make sure all the comorbidities are taken care of, not by just yourself but by a multidisciplinary care.”

“HS should be managed as a multisystem disease,” she concluded. “Multidisciplinary care is essential. Early detection and management improve quality of life and reduce mortality.”

Reference

Gottlieb A. Co-morbidities of hidradenitis suppurativa. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.