The complications of hidradenitis suppurativa can be extensive, affecting both physical health and emotional wellbeing.
Because hidradenitis suppurativa is a chronic, inflammatory condition that often worsens over time, early care is key. Without proper treatment, the disease may shift from simple abscesses to deep scarring, widespread infections, and serious emotional distress. When people understand the complications of hidradenitis suppurativa, they can prepare better and make smart choices with their healthcare teams.
Scarring, Skin Damage, and Movement Limits
One of the most common complications of hidradenitis suppurativa is scarring. Ongoing inflammation destroys skin tissue. Over time, this creates thick, painful scars. These scars often appear over joints or other sensitive areas. They may look raised or discoloured and feel tight or sore.
As the disease continues, sinus tracts may form and rupture again and again. These tracts create hard, rope-like tissue under the skin. In later stages, this can lead to disfigurement and make it harder to move, especially in the underarms, groin, or buttocks.
Fistulas, Infection, and Systemic Risk
Fistulas are another serious issue. These are unusual tunnels that form between parts of the skin or even link to internal organs. In people with HS, fistulas come from repeated flare-ups and infections. They connect abscesses, leak pus, and are very hard to treat. Surgery is often needed, but fistulas may still return.
If ignored, they can cause ongoing pain, bleeding, or even whole-body inflammation. This is why doctors often push for early care when fistulas start to form.
Another big concern is bacterial infection. Even though HS is not caused by bacteria, open wounds and draining abscesses are easy targets for germs. Staph or Pseudomonas are common invaders. These bugs can cause local pain or even spread through the body. In the worst cases, people may develop cellulitis or sepsis.
Using antibiotics too often might also lead to drug resistance, making future infections harder to treat.
Lymphoedema, Skin Cancer, and Fatigue
Scar tissue from hidradenitis suppurativa can block the normal flow of lymph fluid. This causes a complication known as lymphoedema. It happens most often in the groin or armpits. The skin swells, feels tight, and can become painful. Lymphoedema may also raise the risk of new infections.
When not treated, it becomes a repeating cycle: swelling causes infection, and infection worsens swelling.
One rare but serious complication of hidradenitis suppurativa is skin cancer—specifically, squamous cell carcinoma (SCC). It mostly shows up in long-lasting HS cases, especially around the buttocks or anal area.
The risk grows for people with Hurley Stage III disease. Sadly, the cancer can look like a normal lesion or scar. Many times, it goes unnoticed. Doctors should check for non-healing wounds and do biopsies when needed.
Ongoing inflammation and drainage can also lead to anaemia. This is most common in women who lose small amounts of blood over time. They may feel tired, dizzy, or weak. These symptoms affect work, exercise, and relationships. Blood tests and iron supplements can help improve this issue.
Emotional, Social, and Intimate Effects
The psychological effects of HS are deep and long-lasting. Many people with complications of hidradenitis suppurativa feel depressed or anxious. They may avoid going out or feel embarrassed by odour, leaks, or how their skin looks.
Some avoid close relationships altogether. In more severe cases, this stress can lead to total social withdrawal or even thoughts of suicide. Because of this, mental health care should always be part of the treatment plan.
HS also makes work harder. Many people with moderate or severe disease struggle with full-time jobs. Painful flare-ups make walking or sitting hard. Doctors’ appointments and dressing changes break up workdays.
As a result, some people lose jobs or fall behind financially. This makes stress even worse and can speed up disease progression.
Intimacy, Medication Side Effects, and Quality of Life
Many people with hidradenitis suppurativa have intimacy problems. This is especially true when the groin or private areas are affected. Pain, discharge, and scarring make sexual contact difficult or embarrassing.
Shame and fear of rejection can also block closeness with others. Doctors should gently talk about these topics and offer both physical and emotional help.
Long-term medicine use brings its own set of challenges. Biologics, antibiotics, or hormone treatments may cause side effects. These range from tummy problems to low mood or weak immune systems.
Doctors must check blood work and talk often with patients about how the meds make them feel. The goal is to balance good results with low risk.
Managing the Complications of Hidradenitis Suppurativa
The complications of hidradenitis suppurativa touch almost every part of life. From painful skin changes to missed workdays and strained relationships, the effects go far beyond the skin.
Because of this, strong and early treatment is key. Patients need regular care from dermatologists, surgeons, mental health professionals, and other specialists.
When care teams work together and treat the whole person—not just the skin—people with hidradenitis suppurativa can avoid many complications. They can feel stronger, stay connected, and live fuller lives despite the condition.
