Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful lumps, abscesses, and draining tunnels to form under the skin, most often in the armpits, groin, buttocks, and under the breasts — areas rich in sweat glands and hair follicles. Because HS causes recurring pain, unpredictable flares, visible scarring, and drainage that can be difficult to conceal, its psychological impact is substantial and well documented. A 2020 systematic review and meta-analysis in the Journal of the American Academy of Dermatology, drawing on 27 studies with sufficient data for pooled analysis, found that 26.5% of people with HS experience depression (compared with 6.6% of those without HS) and 18.1% experience anxiety (compared with 7.1% of those without HS).
The same analysis found that people with HS have more than double the odds of depression (odds ratio 2.54) and double the odds of anxiety (odds ratio 2.00) compared with people without the condition, with these associations holding up consistently across sensitivity analyses using different diagnostic methods and control groups. The researchers also found that HS is linked to higher use of antidepressant and anti-anxiety medications, and to higher rates of suicidality — underscoring that the emotional toll of HS is not incidental but a core part of the condition that deserves direct clinical attention. Because HS is chronic, often painful, and carries significant social stigma due to its location and odor from drainage, integrating mental health support into HS care is essential rather than optional.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa is a long-term inflammatory skin condition in which painful nodules, abscesses, and interconnected tunnels (sinus tracts) form beneath the skin, typically in areas where skin rubs together such as the armpits, groin, inner thighs, buttocks, and under the breasts. It is thought to begin with blockage and inflammation of hair follicles, and its exact cause involves a combination of genetic predisposition, immune system dysfunction, and hormonal factors, though it is not caused by poor hygiene. There is no cure, but treatment options include topical and oral antibiotics or anti-inflammatory medications, biologic drugs that target the immune system, hormonal therapy, laser treatments, and in more severe or long-standing cases, surgery to remove affected tissue.
Common Struggles and Everyday Signs
- Chronic, unpredictable pain. Nodules and abscesses can flare with little warning, causing significant pain that interferes with sitting, walking, raising one's arms, or sleeping through the night.
- Visible drainage and odor concerns. Because HS lesions can drain fluid, many people describe constant worry about leaking through clothing or others noticing a smell, leading to avoidance of closely fitted clothing or physical closeness.
- Delayed diagnosis and feeling dismissed. HS is frequently misdiagnosed as recurrent boils or infections for years before correct diagnosis, and many people report feeling unheard or judged by healthcare providers along the way.
- Avoidance of intimacy and social situations. Because HS often affects the armpits, groin, and buttocks, many people withdraw from romantic relationships, swimming, exercise, or other situations involving exposed skin or physical closeness.
- Scarring and body image distress. Repeated flares can leave permanent scarring and skin changes in sensitive areas, which many people describe as a source of ongoing grief, shame, or altered sense of self.
Why It Matters for Wellbeing
The 2020 meta-analysis found that roughly one in four people with HS experiences depression and nearly one in five experiences anxiety — both at double or more the odds seen in people without the condition — and that HS is also linked to elevated suicidality. Because HS often affects intimate, hard-to-conceal areas of the body and carries genuine physical pain alongside social stigma around drainage and odor, its emotional burden goes well beyond typical skin-condition concerns. This matters because the same research found people with HS are more likely to be prescribed antidepressants and anti-anxiety medications, suggesting that clinicians are already recognizing — even if imperfectly — that mental health support needs to be built into HS care from the start, not added only after a crisis.
Coping and Treatment Approaches
Because HS involves ongoing, often severe physical pain, many of the pacing and self-advocacy strategies described in our guide to chronic pain apply directly, particularly around communicating pain levels to providers and pacing activity around flare cycles. HS also shares much in common with other chronic, visible skin conditions: people managing psoriasis and eczema often describe similar experiences of unpredictable flares, treatment fatigue, and the emotional weight of a condition others can see or notice, and coping approaches that help with those conditions frequently help with HS too. Because HS commonly involves scarring and changes to sensitive areas of the body, working through the concerns described in our body image guide can help build a more compassionate relationship with a body that has been shaped by the condition. Given the documented links to depression, anxiety, and suicidality, seeking mental health support alongside dermatologic or surgical treatment — rather than after symptoms become severe — is strongly supported by the research.
Everyday Tips
- Ask about mental health alongside skin treatment. Given how common depression, anxiety, and suicidal thoughts are in people with HS, it's entirely appropriate to raise mood concerns during dermatology visits, not just questions about lesions or pain.
- Build a flare-response plan in advance. Having a simple plan for pain relief, wound care, and rest ready before a flare starts can reduce the sense of being caught off guard and losing control.
- Seek out HS-specific support communities. Because HS is often misunderstood or misdiagnosed, connecting with others who have the condition can reduce isolation and provide practical advice that friends and family may not be able to offer.
- Advocate persistently for proper diagnosis and care. Given how often HS is initially misdiagnosed, it's reasonable to seek a second opinion or a dermatologist experienced with HS if symptoms are being dismissed as routine boils or infections.
- Take suicidal thoughts seriously and reach out for help. Because research links HS to elevated suicidality, any thoughts of self-harm are worth discussing openly with a healthcare provider or a crisis line without delay or embarrassment.