Complications of HS: What you need to know

HS causes painful lesions deep in the skin. Some common areas they develop include:

• between the anus and groin
• around the groin
• on the thighs
• under the armpits
• under the breasts
• near the waist or lower abs
• around the anus

If HS lesions occur in areas such as the groin or under the armpits, they could cause the person to lose range of motion due to the pain. In addition, thickening scars can cause a reduction in movement.

Deep lesions or tunneling can cause severe, long-term pain. In some cases, a person may need to take prescription-strength pain medication to help cope with the pain.

The pain typically develops where current or past nodules have formed. A person can talk with a doctor about prescription medication to help manage the pain.

According to the American Academy of Dermatology (AAD), people with HS are at higher risk of developing skin infections.

In a 2020 study, researchers found that both adults and children with HS had a higher chance of developing bacterial skin infections. They also found that people with HS had a higher risk than people with psoriasis or atopic dermatitis.

Finally, the researchers noted that infections lead to higher rates of mortality and costs associated with treatment.

There are several different types of skin infections. They differ in the underlying cause, the associated symptoms, and the best treatments.

Cellulitis is a type of bacterial infection that occurs deep in the skin. Some common symptoms of cellulitis include:

• pain
• warmth on the skin
• fever
• headache
• weakness
• chills
• red or discolored streaks leading from the site of infection
• tenderness
• swelling and discoloration of the skin

Some possible treatments include:

• taking oral or IV antibiotics
• undergoing surgery
• elevating the area
• resting
• keeping the area clean and dry

Other infections may have similar symptoms and treatments. A person should discuss their symptoms with a doctor.

Lymphedema occurs when lymphatic fluid builds up in the body, preventing the lymphatic system from properly transporting the fluid. It often results from damage or an infection. According to a 2017 paper, lymphedema is one possible complication of HS.

There are two types of lymphedema: primary and secondary. When lymphedema occurs due to HS, it is known as secondary lymphedema.

Some possible signs and symptoms associated with the condition include:

• swelling in the arms or legs
• difficulty sleeping
• hair loss
• a heavy feeling in the swollen arm or leg
• skin that feels tight
• difficulty moving a joint in the leg or arm
• itchy legs or toes
• clothes, shoes, or jewelry feeling tight
• thickening of the skin, possibly with warts or blisters
• a burning sensation in the legs

Some possible treatments for lymphedema include:

• losing weight, if appropriate
• exercising
• wearing pressure clothing
• caring for the skin
• bandaging swollen limbs
• undergoing laser therapy
• undergoing compression therapy
• undergoing combined physical therapy
• undergoing massage therapy

As HS lesions develop and heal, they can lead to scarring. Over time, as the body produces more scar tissue in the same area, these scars can thicken and cause restricted movement.

There are several potential treatment options available for reducing the severity of scarring, though early treatment of HS symptoms can help prevent scarring from occurring in the first place.

Some possible treatment options that can help reduce scarring for people with HS include scar massage and laser resurfacing.

Microneedling and microdermabrasion are common treatments for general scarring, but there is no evidence to suggest that they help with HS scars. People with active lesions from HS should avoid these procedures.

According to a 2017 paper, one possible complication of HS is the formation of sinus tracts. Sinus tracts are tunnels that form within the soft tissue, and they can break open on the skin’s surface.

The tunnels can prevent sores on the skin from healing and cause additional lesions to form on the skin.

Treating HS can help prevent tunnels from forming.

Healthcare professionals often describe HS as a debilitating condition. It can cause people to feel embarrassed and to want to avoid social interactions with others.

In one smaller study, researchers found that people with HS often reported restriction of movement despite not presenting with inflammation or other symptoms.

They recommended that people continue their treatment plans, which often include psychological treatment.

The AAD lists both anxiety and depression as common complications of HS. Anxiety may be due to not understanding or knowing when the next lesion may appear. Depression may result from a diminished quality of life as well as social isolation and missed work, school, or social engagements.

People with HS have an increased risk of developing squamous cell carcinoma, which is a type of skin cancer. It is most common in males who have had lesions around their genitals for years, but it can affect anyone who has had HS for a number of years.

This type of skin cancer is generally not life threatening. It can present in several different ways, including:

• as a horn-like shape from the skin
• as a rough, reddish patch of skin
• as an area that resembles an age spot
• as an open sore in an old scar
• as a wart-like growth
• as a dome shaped growth
• as an open sore with raised borders

According to some research, squamous cell carcinoma at the mucous membranes — such as those in the anogenital region — can present an additional risk.

Treatment for squamous cell carcinoma can vary, but it often involves the surgical removal of the cancer. If surgery is not an option, a doctor may recommend radiation. In some cases, a person may consider signing up for treatment with a clinical trial.

A doctor may also recommend simply monitoring the cancer for a while after discovery.

A person should talk with a doctor about the best treatment for them.

The best way to prevent complications is to work with a doctor or a healthcare team to develop an effective treatment plan for HS.

According to the AAD, a typical treatment plan involves the following parts:

• medications
• in-office treatments, such as surgeries and procedures
• skin care routines
• pain control
• treatment of infections
• wound care

In addition to formal treatments, a person can take steps to help treat their HS symptoms at home. Some at-home treatments that a person can try for HS include:

• avoiding smoking
• applying heat to any lumps
• losing weight, if appropriate
• watching for symptoms of depression or anxiety
• wearing loose-fitting clothing
• keeping all dermatologist appointments
• joining a support group for people with HS

HS can cause painful lesions on the skin and lead to several serious complications. The best way to prevent complications is to treat and manage HS to help slow the progression of the condition.

Potential complications can include mental health concerns, such as social isolation, depression, and anxiety, as well as physical conditions, such as infections and scarring.