Managing the Psychological Toll of HS

Hidradenitis suppurativa (HS) is more than a skin condition. The chronic pain, drainage, scarring and unpredictability of flares can take a significant emotional toll. Research consistently shows that people living with HS have higher rates of depression and anxiety and reduced quality of life compared with the general population and even with individuals with some other chronic skin diseases. Here’s what patients should know.

Why does HS affect mental health?

HS often involves painful nodules and abscesses in sensitive areas like the armpits, groin, buttocks and under the breasts. Lesions may drain fluid with an odor and leave visible scars. Because these areas are intimate and symptoms can feel embarrassing, many patients report shame, social withdrawal or fear of judgment.

Pain and sleep disruption also play a role. Chronic inflammation and recurring flares can interfere with work, exercise and relationships. Over time, this can contribute to emotional exhaustion and low mood.

Are depression and anxiety common in HS?

Yes. Studies show that people with HS are more likely to experience depression and anxiety than the general population. Some research has also identified increased risk of suicidal thoughts, underscoring the seriousness of the mental health burden associated with HS.

If you’re experiencing persistent sadness, loss of interest, hopelessness, irritability, panic attacks or thoughts of self-harm, it’s important to speak with a health care professional right away. Mental health care is a critical part of HS management.

How does HS affect self-esteem and body image?

HS often develops in adolescence or young adulthood, a time when body image can already feel vulnerable. Visible scarring, drainage or the need for dressings can make people feel self-conscious. Some patients avoid social activities, intimacy or wearing certain clothing due to fear of flares or odor.

Dermatology organizations emphasize that HS is a medical condition — not a result of poor hygiene — and that stigma can worsen emotional distress. Education and open conversation can help reduce shame.

Can HS impact relationships and intimacy?

Yes. Painful lesions in intimate areas may make physical closeness uncomfortable. Fear of judgment or misunderstanding can create anxiety around dating or long-term partnerships. Honest communication with partners can help. Some patients find it useful to share educational resources, such as those available at the HS Foundation, so loved ones better understand that HS is not contagious and not caused by hygiene habits.

If relationship stress is significant, couples counseling or individual therapy may help create space for supportive communication.

Does inflammation itself affect mood?

Emerging research suggests that chronic inflammatory conditions may be linked to changes in mood. While scientists are still studying the exact mechanisms, ongoing inflammation in the body may influence brain chemistry and contribute to depressive symptoms. This doesn’t mean depression is “just inflammation,” but it highlights the complex mind-body connection in chronic disease.

What coping strategies can help?

Patients often benefit from a multilayered approach:

• Mental health therapy: Cognitive behavioral therapy (CBT) and other forms of counseling can help patients manage anxiety, depression and coping skills.
• Support groups: Connecting with others living with HS can reduce isolation and normalize shared experiences.
• Pain management: Working with your care team to reduce flares and control pain can improve overall well-being.
• Stress reduction: Mindfulness, exercise (as tolerated), journaling or relaxation techniques may help.
• Sleep hygiene: Managing sleep disruption during flares is important for mood stability.

Your dermatologist or primary care physician can refer you to mental health resources if needed.

Should I tell my doctor if I’m struggling emotionally?

Absolutely. Mental health is part of whole-person care. Dermatologists and primary care clinicians increasingly recognize the psychological burden of HS. If you’re struggling, say so. Your provider can screen for depression or anxiety and connect you with appropriate support.

You deserve care that addresses both your skin and your emotional health.

Is there hope?

Yes. While HS is chronic, treatment options have expanded, including biologic therapies and surgical approaches for more severe disease. Better symptom control often improves quality of life. Just as importantly, awareness of HS is growing, helping reduce stigma.

Living with HS can be challenging, but you are not alone, and support is available.