Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition characterized by painful, deep-seated nodules and abscesses. These lesions form primarily in areas where skin rubs together, such as the armpits, groin, and under the breasts. HS is caused by blocked hair follicles, which rupture beneath the skin, leading to inflammation. Recurrent inflammation and pus pockets can lead to the formation of tunnels, known as sinus tracts, and significant scarring over time. Due to the severity of symptoms, people often worry whether HS poses a direct threat to life.
Directly Answering the Mortality Question
Hidradenitis Suppurativa is generally not considered a direct cause of death. A patient rarely succumbs solely due to the presence of the skin lesions. However, the systemic effects of chronic, unmanaged inflammation can significantly affect overall health and contribute to an increased risk of death from related causes.
Studies show that individuals with HS have a higher risk of death from all causes compared to the general population, sometimes indicating a two- to three-fold increased risk. This elevated risk stems from severe, secondary health issues that arise from long-term systemic inflammation, not the skin condition directly. The presence of HS can be a marker for underlying inflammatory processes that impact longevity.
Understanding Disease Severity and Progression
To understand the health risks associated with HS, disease severity is commonly classified using the Hurley Staging System. This system organizes the condition into three distinct stages based on the types of lesions, scarring, and tunneling. It provides a framework for healthcare providers to assess disease progression and determine appropriate treatment strategies.
Hurley Stage I is the mildest form, characterized by isolated abscesses or nodules without sinus tracts or scarring. Stage II involves recurrent, more widespread abscesses that begin to develop sinus tracts—tunnels connecting lesions beneath the skin—alongside some scarring. The most severe form is Hurley Stage III, which involves diffuse involvement across an entire area, with multiple interconnected sinus tracts, widespread abscesses, and extensive scarring.
The risk of serious complications rises in tandem with the Hurley stage, as Stage III represents a state of persistent, widespread, and profound systemic inflammation. Extensive tunneling and chronic inflammation in the later stages create an environment where secondary issues are more likely to develop. This progression underscores why the long-term management of HS is aimed at preventing the disease from advancing to these more severe categories.
Serious Long-Term Complications
The true threat to health from HS arises from the systemic complications of chronic, uncontrolled inflammation, which can affect organs beyond the skin. One serious concern is the risk of systemic infection, or sepsis, which develops when bacteria from deep abscesses and sinus tracts spread into the bloodstream. Sepsis is a life-threatening medical emergency that can lead to rapid organ failure if not treated immediately.
Another serious long-term complication is the development of Squamous Cell Carcinoma (SCC), a type of skin cancer. This cancer is most often found in chronic, non-healing sinus tracts and scars, particularly in long-standing cases of HS. Although uncommon, the fatality rate for SCC that develops within HS lesions can be high, highlighting the importance of monitoring persistent wounds.
Chronic systemic inflammation can also lead to Systemic Amyloidosis, a rare disorder where abnormal protein (Amyloid A) is deposited in organs like the kidneys. This condition results from the body’s prolonged inflammatory response. Amyloidosis can ultimately lead to organ damage, such as kidney failure, typically only seen in severe, unresponsive HS cases.
Furthermore, the chronic inflammatory state is strongly associated with an increased risk of cardiovascular and cerebrovascular events, such as heart attack and stroke. This link is believed to be driven by the same inflammatory molecules that cause the skin lesions, which also damage blood vessels over time.
Improving Long-Term Prognosis Through Treatment
The risks associated with HS are significantly mitigated through modern, consistent treatment. The primary goal of intervention is to reduce the overall inflammatory burden and prevent the disease from progressing to higher Hurley stages. Early diagnosis is important because it allows for a comprehensive treatment plan before irreversible scarring and widespread tunneling occur.
Treatment strategies are tailored to disease severity. Mild cases (Hurley Stage I and mild Stage II) often begin with topical therapies like clindamycin or resorcinol. Moderate to severe HS requires systemic therapies, including courses of oral antibiotics that function as anti-inflammatory agents, and sometimes hormonal therapies. For patients with severe or refractory disease, biologic medications like adalimumab are available to target specific inflammatory pathways.
Surgical intervention also plays a role, ranging from targeted removal of a single lesion to extensive excision of entire affected areas in advanced cases. Procedures like deroofing, which involves removing the roof of a tunnel to allow healing from the base, can significantly reduce the potential for recurrence and deep infection. Adherence to a multidisciplinary care plan—including medical therapy, surgery, and lifestyle adjustments—is the most effective approach to managing HS and reducing indirect long-term health risks.