Hidradenitis suppurativa (HS) is not directly deadly, but it is associated with a significantly higher risk of dying from related complications. A large Danish population study of over 35,000 patients found that people with HS had a 35% increase in all-cause mortality and a 95% increase in cardiovascular death compared to the general population. The disease itself, characterized by painful abscesses and tunneling wounds in the skin, rarely kills on its own. But the chronic inflammation it drives, the conditions it travels with, and the toll it takes on mental health all shorten lives.
How HS Affects Heart Health
The most significant mortality risk for people with HS comes from cardiovascular disease. That same Danish cohort study found a 57% elevated risk of heart attack, a 33% elevated risk of ischemic stroke, and a 53% increase in major adverse cardiovascular events overall. These aren’t small numbers, and they hold up even after researchers account for other risk factors like smoking and obesity.
The connection likely runs through chronic systemic inflammation. HS keeps the immune system in a constant state of activation, releasing inflammatory signals that damage blood vessel walls over time. This is similar to what happens in other chronic inflammatory conditions like rheumatoid arthritis and psoriasis, which also carry elevated cardiovascular risk. The inflammation doesn’t stay confined to the skin folds where HS lesions appear. It circulates throughout the body.
Metabolic Conditions Compound the Risk
People with HS carry dramatically higher rates of metabolic disease. In a diverse safety-net population study, 74% of HS patients were obese compared to 50% of controls, 39% had diabetes versus 19%, and 46% had hypertension versus 32%. After controlling for other variables, HS patients had 2.32 times the odds of diabetes and 1.66 times the odds of hypertension. Each of these conditions independently raises the risk of heart attack, stroke, and early death, and they tend to cluster together in HS patients, compounding the danger.
Whether HS directly causes these metabolic problems or shares underlying mechanisms with them is still being sorted out. But the practical implication is the same: if you have HS, monitoring your blood sugar, blood pressure, and weight matters for your long-term survival, not just your skin.
Serious Infections
HS lesions create open wounds that can become infected, but the infection risk extends beyond the skin. A retrospective study of 834 adults with HS found that 6.35% were hospitalized for serious infections unrelated to the skin over a five-year period. Among those hospitalized, about 10% of cases involved sepsis or bloodstream infections. Sepsis is a life-threatening emergency where the body’s response to infection starts damaging its own organs. While this scenario is uncommon, people with severe HS who have large, chronically draining wounds are at greater risk.
Cancer Risk From Chronic Wounds
Long-standing HS lesions can, in rare cases, transform into squamous cell carcinoma, a type of skin cancer. The prevalence ranges from 0.5% to 4.6% of HS patients, and it tends to occur in areas that have been inflamed for years or decades. This is a well-recognized pattern in medicine: any wound that never fully heals carries a small risk of malignant change over time.
When squamous cell carcinoma does arise from HS, it tends to be more aggressive than typical skin cancers, carrying higher rates of morbidity and mortality. People with darker skin tones may face worse outcomes from HS-associated skin cancer, despite having a generally lower baseline risk of squamous cell carcinoma. This makes long-term monitoring of chronic HS wounds important, particularly if the character of a lesion changes.
Suicide Risk
HS takes a severe psychological toll. The pain is chronic, the wounds can produce odor and drainage, and many people with the condition experience shame and social isolation. A cohort study found that HS patients had 2.42 times the risk of dying by suicide compared to the general population, even after adjusting for lifestyle and demographic differences. This means the disease itself, likely through its impact on quality of life, independently contributes to suicide risk beyond what can be explained by factors like age, sex, or socioeconomic status.
Rare but Severe Organ Damage
In exceptional cases, decades of uncontrolled HS inflammation can lead to a condition called secondary amyloidosis, where abnormal proteins build up in organs, particularly the kidneys. This can progress to kidney failure requiring dialysis. The complication is rare enough to be described as “exceptional” in the medical literature, but it underscores why controlling the inflammatory burden of HS matters for more than just comfort.
Treatment Can Improve Survival
There is encouraging evidence that treating HS with biologic medications meaningfully reduces mortality. A study from the Mayo Clinic compared HS patients treated with biologics to matched patients who were not. The biologic-treated group had a mortality rate of just 1.5% over 60 months, compared to 6.5% in the untreated group. That is a substantial difference, and it suggests that suppressing the chronic inflammation at the root of HS doesn’t just improve symptoms but may extend life.
These findings reinforce the idea that HS is not merely a skin nuisance. It is a systemic inflammatory disease with measurable effects on cardiovascular health, metabolic function, infection risk, and mental health. The good news is that the same treatments that reduce flares and improve quality of life also appear to reduce the broader risks that make HS dangerous over time.