Hidradenitis Suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin condition that causes painful, deep-seated lumps to form under the skin. These lesions often occur in areas where skin rubs together, such as the armpits, groin, and under the breasts, and they can rupture, draining fluid and pus. The condition involves an immune system overreaction to clogged hair follicles and is not contagious or caused by poor hygiene. Chronic fatigue is recognized as one of the most debilitating, non-skin related symptoms of HS.
The Confirmed Link Between HS and Exhaustion
Fatigue in people living with HS is a profound, persistent exhaustion that is often not relieved by rest or sleep. Clinical studies confirm this experience, showing that fatigue is a widespread complaint affecting approximately 40% of HS patients. This sense of depletion is so common and severe that it is now considered a systemic manifestation of the disease, rather than merely a side effect of poor health.
Research comparing HS patients to the general population shows that those with the condition report significantly higher overall fatigue scores. The intensity of this fatigue directly correlates with the severity of the HS itself. This finding solidifies the recognition of exhaustion as an inherent part of the disease process. Due to its high prevalence, fatigue is now included in core outcome sets for clinical trials, ensuring future research measures its impact.
Biological Mechanisms Driving Systemic Fatigue
The primary driver of the profound fatigue experienced in HS is chronic, systemic inflammation. HS involves a heightened immune response that constantly releases pro-inflammatory signaling molecules called cytokines into the bloodstream. These circulating cytokines act systemically, directly affecting various parts of the body, including the central nervous system.
Specific cytokines, such as Tumor Necrosis Factor-alpha (TNF-α) and Interleukin-1 beta (IL-1β), are found at significantly elevated levels in the skin and blood of HS patients. These molecules are known to induce “sickness behavior,” which includes feelings of malaise, reduced activity, and fatigue. In the brain, these inflammatory signals interfere with neurotransmitters like dopamine and noradrenaline. This interference disrupts the neural pathways that regulate motivation, wakefulness, and energy metabolism, leading to physical and mental exhaustion.
The constant inflammatory barrage requires an ongoing deployment of energy resources by the immune system, diverting metabolic fuel away from other bodily functions. This internal battle results in a chronic energy deficit at the cellular level. The body is so busy fighting inflammation that it lacks the necessary resources to support normal activity and concentration, manifesting as unrelenting fatigue.
Indirect Contributors to Energy Depletion
Beyond the direct inflammatory mechanisms, several secondary factors contribute to energy depletion for those with HS. Uncontrolled chronic pain is a major contributor, as persistent discomfort from deep lesions continuously drains physical and mental reserves. The body’s response to pain keeps the nervous system in a state of high alert, which is mentally exhausting over time.
Pain, along with the physical discomfort of dressings and drainage, frequently leads to significant sleep disturbance and poor sleep quality. Patients often report difficulty falling asleep or being woken up due to pain or lesion leakage. Insufficient restorative sleep prevents the body from recovering fully, directly contributing to severe daytime fatigue and reduced cognitive function.
The psychological burden of managing a visible, painful, and often misunderstood condition also compounds the exhaustion. The stress, anxiety, and depression associated with HS—with depression affecting an estimated 17% of patients—require a substantial emotional toll. This mental exhaustion depletes energy stores further, creating a vicious cycle where pain prevents sleep, and lack of sleep exacerbates inflammation and psychological distress.
Managing Fatigue When Living With HS
The most effective way to manage HS-related fatigue is by aggressively treating the underlying inflammatory disease. Biologic medications that target elevated cytokines, such as TNF-α inhibitors, have shown success in reducing inflammation and improving fatigue levels. Consistent compliance with prescribed medical treatment, including prompt management of flares, is a primary strategy for lessening systemic exhaustion.
In addition to medical interventions, strategic lifestyle adjustments can mitigate indirect factors contributing to energy depletion. Establishing strict sleep hygiene is important, involving a consistent sleep schedule and optimizing the bedroom environment for rest. Addressing pain, perhaps with the help of a pain specialist, can also reduce nocturnal awakenings and improve sleep quality.
Gentle, regular exercise, even a short walk, can be beneficial for boosting energy levels despite initial fatigue. Choose low-impact activities that do not aggravate lesions or cause excessive friction, such as swimming or yoga. Dietary adjustments, like avoiding potential inflammatory triggers such as dairy products, brewer’s yeast, and high-glycemic foods, may also help lower systemic inflammation.
Incorporating stress reduction techniques, such as mindfulness, meditation, or structured routines, helps lower the psychological burden of the condition. Consistent self-care and open communication with a healthcare team about fatigue are important steps. Treating HS effectively is the foundation for breaking the cycle of inflammation-induced exhaustion and reclaiming lost energy.