Does hidradenitis suppurativa cause metabolic problems or systemic inflammation?

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that causes painful nodules and abscesses, usually in areas with apocrine glands. While it primarily affects the skin, research increasingly shows that HS is not just a localized condition. It is associated with systemic inflammation and metabolic issues, meaning it can affect the whole body. This answer explains what the evidence shows about these connections.

What the research says

A narrative review explains that HS is part of a broader systemic inflammatory state closely linked to metabolic dysfunction. The review describes a process called meta-inflammation, a chronic low-grade inflammation driven by metabolic imbalance, which connects obesity, insulin resistance, and immune dysregulation to HS. This shared pathway involves pro-inflammatory cytokines like TNF-α, IL-1β, and IL-6, which drive both skin severity and metabolic comorbidities, creating a self-perpetuating cycle ².

A 2026 proteomic study found that patients with HS have significantly higher levels of 37 inflammatory proteins compared to healthy controls, including IL-6, IL-17A, and others, even in early disease stages. This provides direct evidence of systemic inflammation in HS ⁶.

Epidemiological data also support the link. A systematic review found that HS patients have higher odds of diabetes and hypertension in North America compared to other regions, and depression and thyroid disorders are also more common ³. Another review notes that case-control studies frequently evaluate the association between HS, metabolic syndrome, and other systemic comorbidities ⁷. Obesity is a known risk factor and comorbidity; a dermatology review lists HS among chronic dermatoses associated with obesity ⁸.

While these sources consistently point to a connection, the exact cause-and-effect relationship is not fully established. Some studies are retrospective, which limits the ability to confirm causality ⁷. However, the overall evidence strongly suggests that HS involves systemic inflammation and metabolic problems.

What to ask your doctor

• Given my HS, should I be screened for metabolic syndrome, diabetes, or high blood pressure?
• How does my weight or diet affect my HS symptoms and inflammation?
• Are there lifestyle changes, like weight management, that could help reduce both my skin symptoms and metabolic risks?
• Could my HS be contributing to my fatigue or other systemic symptoms?
• What can I do to monitor my overall health given the link between HS and systemic inflammation?