Stress Can Make Hidradenitis Suppurativa Worse: Here’s How To Manage It

Hidradenitis suppurativa (HS) impacts a lot more than just your skin. Even small adjustments — like wearing different clothes — can be a big deal emotionally. Add the stress of dealing with a chronic illness to the daily challenges of life, and it’s easy to feel overwhelmed.

Unfortunately, those tend to be the moments when HS is at its worst.

We asked dermatology specialist Patrizia Visconti, PA-C, to explain the connection between hidradenitis suppurativa and stress. It turns out, your mental health plays a significant role in your skin’s health. She shares some stress relief tips. Paired with medical treatments, they might reduce the frequency and severity of your HS flares.

Is stress causing your hidradenitis suppurativa flare-up?

Inflammation is an immune response that helps us recover from illness and injury. It’s a good thing ... unless it becomes chronic. Chronic inflammation can damage the same body systems it exists to protect.

But guess what? Both stress and HS can cause chronic inflammation. And chronic inflammation makes both stress and HS worse.

A hidradenitis flare usually has more than one cause. But yes, stress frequently belongs on the list.

“It works the other way, too,” Visconti says. “If you just got diagnosed, you’re self-conscious about HS scars, you’re in pain or your condition’s flaring up, your HS can hurt your mental health. It’s a feature of many chronic illnesses.”

Ways to deal with stress

Is there anything more stressful than being told to manage your stress? If it was easy, we’d all do it, all the time!

But there’s good news: Even small steps can make a big difference. Here are a few coping and stress management skills that Visconti recommends.

Play an active role in your care

For many of us, going to the doctor is a stressful experience. And it can be hard to remember your questions, much less ask them. But the best treatment plans are a team effort. Work alongside your provider to develop a treatment plan that fits your needs.

“While there’s no cure for HS, there are lots of treatment options we can try,” reassures Visconti. “The more information you share with us, the easier it will be to rule those treatments in or out.”

And don’t be discouraged if you don’t notice any improvement. Many treatments take time to make a noticeable difference. And you might end up needing to try multiple treatments — or a combination — to get the results you’re looking for.

“Treating HS is a process,” she continues. “So, it’s important to keep an open line of communication with your doctor.” And never stop taking a medication without consulting with your provider.

Join a support group

Researchers aren’t exactly sure how many people are living with HS around the world. Some estimates are as low as 0.053%. Others are as high as 4.1%.

Either way, it’s possible you don’t know anybody else dealing with the unique challenges HS poses. Your family, friends and providers can offer valuable support. But if they don’t have HS, they may not truly appreciate how it impacts you.

That’s why Visconti recommends joining a support group. Online, in-person or hybrid, it doesn’t matter.

“What’s important is knowing you aren’t alone in this experience,” she encourages.

Start a mindfulness practice

There are many ways to incorporate mindfulness into your life. Visconti recommends creating a practice that works for you. Common forms of mindfulness include:

• Purposeful movement like yoga, tai chi or qigong
• Breathwork like box breathing and alternate nostril breathing
• Self-reflection activities like meditation, journaling and art therapy
• Relaxation exercises like progressive muscle relaxation, body scanning and aromatherapy

“There’s lots of research showing mindfulness may help relieve chronic pain, reduce stress and improve quality of life,” Visconti notes.

There isn’t much research on how mindfulness impacts HS specifically. The one study that does exist, though small, was promising.

“It’s one of those things that’s always worth trying,” she continues. “Maybe it will help and maybe it won’t. But it’s free. And it can’t hurt.”

Improve your eating habits

Nutrition, stress, immune health and inflammation are closely linked. But you probably don’t need us to tell you that. After all, “comfort food” tends not to be the healthiest option in the fridge.

If you have HS and are trying to better manage your stress, talk with your dermatologist — or, if possible, a dietitian — about your eating habits. A few small changes might help reduce inflammation, calm your skin and reduce your stress!

Hydrate

HS, like most skin conditions, is more likely to flare up when you’re dehydrated. But did you know that dehydration can affect your mental health, too? It’s true!

“Being dehydrated causes your adrenal glands to produce more of the stress hormone cortisol,” Visconti explains. “If you’re under chronic stress, your cortisol levels stay elevated. That can make hormonal imbalances worse. Which is a problem because hormones play a crucial role in telling you that you’re thirsty.”

It’s a vicious cycle. Stress can lead to dehydration. And research suggests that dehydration increases stress. Many different studies — including one from 2018 and another from 2024 — found that people who drink less water are more likely to say they feel anxious, depressed and even suicidal.

These studies were correlational. So, they can’t prove that water intake affects mental health. But we do know that dehydration negatively impacts HS symptoms. And that’s reason enough to drink up!

Stay physically active

When you’re first diagnosed with HS, this advice can be confusing. Sure, exercising is a proven mood-booster. But all that sweat and friction can cause a flare-up. That’s why Visconti recommends low-impact exercises, like:

• Rowing
• Cycling
• Swimming
• Yoga
• Walking

“If you want to keep doing high-impact workouts, try doing them inside, in an air-conditioned space,” she suggests. “And make sure you shower off as soon as possible.”

Visconti also emphasizes the importance of listening to your body.

“If your symptoms are flaring, it’s important to moderate your activity. And if you’ve got an abscess or drainage, don’t share gym equipment with other people,” she adds.

Avoid social isolation

When you have HS, it can be easy to become a homebody without realizing it. Maybe you’re worried people will make fun of your nodules, abscesses and fistulae. Maybe the inconvenience of bathing and re-dressing your wounds before date night isn’t worth it. Or maybe you’d love to go to bowling night but pain won’t let you.

It’s all completely understandable. But Visconti urges you to talk to your provider if your condition is impacting your social life.

“Loneliness and social isolation can negatively impact your health,” she states. “So, it’s important that we address it just like we would any other HS symptom.”

Get plenty of sleep

Part of the reason HS can be so stressful is the impact it can have on the quality of your sleep. To make matters worse, a 2023 study found that having HS increases your risk for sleep disorders like obstructive sleep apnea.

Nothing calms the mind and heals the body like a good night’s sleep. If you aren’t getting the sleep you need — because of HS, stress or anything else — talk to your doctor. If they can’t help, they’ll refer you to a sleep medicine specialist.

Take mental health symptoms seriously

A mental health provider can be a valuable addition to your HS care team. Research shows that people living with HS have a higher-than-average chance of being diagnosed with psychiatric conditions like:

• Depression
• Anxiety
• Bipolar disorder (BPD)
• Schizophrenia
• Substance use disorder (SUD)

Research also suggests that suicidal thoughts are common. One study found more than 20% of people living with HS think about ending their lives.

If you’re having suicidal thoughts, it’s vital that you reach out to your mental health provider (or any other medical professional) for help. If you’re in urgent need, there’s 24/7 help available:

• If you live in the U.S., call, text or visit the 988 Suicide and Crisis Lifeline.
• If you live outside the U.S. or want to be connected with local resources, visit the International Association for Suicide Prevention website — they have a searchable database of crisis helplines.

Take stress seriously

When you think about HS symptoms, chronic stress probably isn’t the first thing that comes to mind. But what happens in your body affects your mind (and vice versa). That’s why it’s important to note — and tell your provider about — new or worsening symptoms of chronic stress.

“Your provider might not be able to address your stress levels,” Visconti notes. “But they’ll know how to get you the help you need. They’ll also keep those symptoms in mind when prescribing treatments.”

Living with HS can amplify stress, no question about it. But with help from your family, friends and providers, you can develop the coping and stress management skills you need to live a happier, healthier life.