Hidradenitis Suppurativa (HS) is a chronic, often painful condition characterized by acute inflammation and pain. While many HS flares can be managed at home or through routine appointments, others demand prompt medical attention. Understanding the distinction between routine management, urgent care, and hospital intervention is crucial for protecting your health. This framework helps assess if a flare’s severity requires immediate emergency services, urgent medical assessment, or a scheduled consultation with your regular healthcare provider.
Systemic Warning Signs Requiring Emergency Room Care
When an HS flare causes signs that the body’s entire system is under stress, it signals a potential life-threatening complication requiring immediate emergency room care. The most serious concern is sepsis, the body’s extreme response to an infection that has spread from a skin lesion into the bloodstream. Sepsis can lead to organ dysfunction and must be treated as a medical emergency.
Any temperature above 101.5°F (38.6°C) or a dangerously low temperature below 96.8°F (36°C) is a major red flag for a systemic infection. An infection spreading from deep abscesses or sinus tracts can trigger a widespread inflammatory reaction. Look for signs such as persistent chills, uncontrollable shaking, or intense sweating, which indicate the body is struggling to regulate its core temperature.
Changes in mental state are serious systemic indicators, including new confusion, extreme drowsiness, or difficulty staying awake. These neurological changes suggest the infection is affecting organ function and blood flow to the brain. A rapid heart rate (tachycardia), rapid breathing, or feeling dizzy and faint are also signs of hemodynamic instability and shock.
If you experience these systemic symptoms, seek emergency medical treatment immediately, as intravenous antibiotics and supportive care are necessary. Uncontrolled, massive bleeding from a ruptured lesion, though rare, also constitutes an emergency requiring immediate intervention to stop blood loss. These situations warrant a direct trip to the hospital or a call to emergency services.
Rapidly Worsening Localized Symptoms Needing Urgent Medical Attention
Some localized symptoms do not involve systemic failure but still demand urgent professional intervention within hours. These situations require immediate procedural treatment, such as drainage or aggressive antibiotics, that cannot wait for a routine appointment. The priority is preventing a severe localized infection from becoming systemic.
Cellulitis is an urgent localized sign, appearing as rapidly spreading redness, warmth, and swelling extending beyond the lesion borders. If you notice red streaks radiating outward from the flare or the area becomes firm and hot, this suggests a bacterial infection is aggressively spreading through deeper skin layers. This localized spread needs immediate attention to prevent it from entering the bloodstream.
An acute pain crisis unresponsive to prescription pain medication is another reason to seek urgent care. If the pain from an abscess or nodule is so severe that it prevents normal movement, sleep, or daily function, it may signal a deeply inflamed or rapidly growing abscess that needs immediate lancing and drainage. Allowing this level of pain to persist can lead to significant emotional distress and physical exhaustion.
The sudden appearance of a large, tense abscess that is growing rapidly over 24 hours also falls under urgent care criteria. These quickly evolving, deep collections of pus can cause tissue damage. They may require immediate surgical de-roofing or drainage by a healthcare provider to relieve pressure and prevent tissue destruction. These symptoms require same-day assessment at an urgent care facility or by an on-call specialist.
When to Consult Your Dermatologist or Primary Care Physician
Many HS symptoms, while uncomfortable, do not require emergency or urgent care and can be addressed by your established medical team. These situations involve chronic management, ongoing symptoms, or stable changes that are concerning over time. The preferred action is to contact your dermatologist’s office or primary care physician during standard business hours.
If you are experiencing a chronic flare impacting your quality of life without signs of systemic infection or rapid localized spread, schedule a routine appointment. This includes persistent, stable pain that is difficult to manage, or lesions that are not healing after several weeks. These issues are best managed through adjustments to your long-term treatment plan, which may involve new oral medications or biologics.
Concerns about medication side effects that are not severe or life-threatening should be directed to your prescribing physician. Mild digestive upset or new skin changes that are not signs of infection are best discussed during a scheduled consultation. Your doctor can assess whether a dosage adjustment or medication switch is necessary.
If you notice new symptoms like joint pain, fatigue, or other issues related to HS comorbidities, consult your physician. These symptoms require a thorough evaluation in a clinical setting to determine if they relate to the underlying systemic inflammation of HS. Utilizing patient portals or calling the office directly for these matters ensures you receive specialized care while keeping emergency resources available for true crises.