Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition characterized by painful, deep-seated lumps, abscesses, and the formation of tunnels, known as sinus tracts, beneath the skin. While flare-ups are often managed at home with prescribed treatments, certain complications or severe symptoms require immediate medical intervention. This information outlines clear criteria for determining when an HS flare-up or complication necessitates emergency hospital treatment. Recognizing these specific signs helps patients seek timely care for potentially serious health issues.
Recognizing Signs of Systemic Infection
The most immediate and serious concern during an HS flare is the potential spread of bacteria from localized lesions into the bloodstream, known as sepsis. Since HS lesions often involve inflammation and bacterial colonization, a secondary systemic infection can develop, requiring immediate hospital care for stabilization.
Symptoms indicating a systemic infection include a high fever, defined as a temperature above 101.5°F (38.6°C), and severe, uncontrollable chills. These signs suggest the body’s overall response to the infection is overwhelmed.
Other indicators include a rapid heart rate (tachycardia) and very rapid breathing, which are physiological attempts to compensate for the spreading infection. Mental status changes, such as sudden confusion, disorientation, or extreme lethargy, suggest the infection is affecting brain function. Extremely low blood pressure is a late-stage sign of septic shock, a life-threatening complication requiring immediate intervention with intravenous fluids and antibiotics. Any combination of these symptoms warrants an immediate visit to the Emergency Room (ER).
Severe Localized Symptoms Requiring Immediate Intervention
While systemic symptoms indicate a body-wide emergency, certain acute, localized symptoms demand immediate medical attention, even without a fever or other signs of sepsis. Excruciating pain that is unmanageable with a patient’s prescribed or over-the-counter pain medication indicates a localized crisis. This level of discomfort often suggests a massive, deep-seated abscess requiring urgent drainage and specialized pain control.
Lesions that cause significant physical obstruction or functional impairment also necessitate immediate intervention. For example, a large abscess in the groin or armpit that severely limits the ability to walk, sit, or move a limb requires swift surgical assessment. Massive, rapid swelling of the affected area, particularly if the skin appears taut and shiny, may indicate cellulitis or a quickly progressing deep tissue infection.
Another acute situation is uncontrolled bleeding from a ruptured lesion, especially if the flow is difficult to stop with simple pressure. Signs of spreading localized infection, such as rapidly expanding redness, warmth, or red streaks radiating away from the lesion (lymphangitis), require prompt evaluation in an acute care setting.
Urgent Situations That Require Specialist Consultation
Some high-priority situations related to HS are urgent but typically do not require an ER visit unless the systemic or severe localized symptoms previously mentioned are also present. A sudden and severe adverse reaction to a new HS medication, such as a biologic or oral therapy, requires immediate contact with the prescribing physician or dermatologist. Symptoms like widespread rash, hives, or difficulty breathing constitute a medical emergency requiring the ER.
A rapidly worsening flare-up that fails to show improvement after 24 to 48 hours of prescribed home treatment is an urgent, non-ER situation. This failure suggests the current regimen is inadequate and requires a swift adjustment by the patient’s dermatologist or HS specialist. The sudden onset of severe, unexplained joint pain or a significant limitation in mobility—complications sometimes associated with HS—should be reported immediately to the specialist. These scenarios necessitate rapid specialist input to modify treatment and prevent further progression.