Hidradenitis Suppurativa Mortality Rate and Life Expectancy

Understanding Hidradenitis Suppurativa and Its Severity

Hidradenitis suppurativa (HS) is a painful, chronic skin condition characterized by inflamed, recurring lesions and abscesses under the skin. While not always life-threatening on its own, HS can significantly impact a person's quality of life. Furthermore, several studies have found associations between HS and an increased risk of serious health complications and mortality.

HS occurs when the hair follicles become blocked and inflamed. This leads to painful nodules and boils forming in areas with apocrine sweat glands, like the armpits, groin, and under the breasts. These lesions tend to recur frequently and can rupture, spreading infection under the skin. The persistent inflammation causes extensive scarring and skin thickening over time.

HS is estimated to affect up to 4% of the population, but its severity varies from mild to profoundly impactful. There are three clinical stages:

• Stage 1 - Single or multiple abscesses with no scarring
• Stage 2 - Recurrent abscesses, scarring, and sinus tract formation
• Stage 3 - Diffuse abscesses and inflammation, extensive scarring, and formation of sinus tracts and tunnels

advanced stages indicate more widespread infection and tissue damage. HS can be a debilitating skin disease, as the painful lesions restrict movement and daily activities.

HS and Associations with Increased Mortality

Several recent studies have investigated whether HS is linked to higher mortality rates compared to the general population. The findings indicate that HS, especially more severe cases, does carry increased risks of premature death.

In a 2010 study published in JAMA Dermatology, researchers followed patients with HS over a 50-year period. They found significantly higher mortality rates among HS patients compared to the general population. The leading causes of death were cardiovascular disease, cancer, and suicide.

A 2019 study in JAMA Dermatology had similar findings from a Danish nationwide cohort of 4,755 HS patients, matched to 23,020 controls. HS patients had a nearly doubled overall mortality rate, with higher risks of death from cardiovascular disease, cancer, respiratory diseases, digestive disorders, and suicide.

Both studies found more advanced HS was associated with greater mortality risk. This link between HS severity and death risk was confirmed in a 2021 meta-analysis aggregating 15 studies with over 27,000 HS patients.

Overall, research indicates people with HS have around a 30-80% higher risk of dying prematurely compared to the general public. The wide mortality rate range is due to differences in study methods and populations.

Factors Contributing to Increased Mortality

There are several factors that may explain why HS can increase a person's risk of dying earlier:

• Severity of inflammation - More severe HS with widespread inflammatory lesions can lead to greater systemic inflammation in the body, raising risks for other diseases.
• Pain and limited mobility - Chronic pain and reduced mobility from HS lesions can contribute to weight gain and loss of fitness, increasing risks for obesity, cardiovascular disease, and diabetes.
• Smoking - Most people with HS smoke or have a history of smoking. This adds risks for various cancers, lung disease, and cardiovascular complications.
• Mental health issues - HS can significantly impact mental health and quality of life. Higher rates of depression and suicide likely contribute to increased mortality.
• Delays in diagnosis/care - Many HS cases go undiagnosed for years. Lack of proper treatment may allow HS to progress, exacerbate complications, and negatively impact health.

Overall, the chronic inflammation and pain of severe HS appears to take a toll on physical and mental health over time, leading to higher risks of potentially fatal health issues.

Specific Causes of Death Associated with HS

While HS patients have higher overall mortality, certain diseases and complications account for many of the excess deaths.

Cardiovascular Disease

Most studies on HS mortality have found cardiovascular diseases are one of the leading causes of premature death. This includes conditions like heart attacks, heart failure, and stroke.

For example, the 2010 JAMA study found cardiovascular mortality rates were 76% higher for women with HS and 90% higher for men with HS compared to the general public.

There are several reasons people with HS may be at increased risk of cardiovascular death:

• Chronic inflammation - Ongoing inflammation from HS lesions may accelerate atherosclerosis and damage blood vessels.
• Obesity - Difficulty exercising due to HS pain/lesions can contribute to obesity, a major heart disease risk factor.
• Smoking - Most HS patients smoke, which significantly increases risks for cardiovascular disease.
• Metabolic syndrome - HS is associated with metabolic disorders like diabetes, dyslipidemia, and hypertension that damage the heart and blood vessels.

For these reasons, HS patients may be more likely to develop blood vessel blockages, atherosclerosis, heart failure, arrhythmias, and other complications that can lead to premature cardiovascular death.

Cancer

After cardiovascular disease, cancer is one of the other leading causes of death among people with hidradenitis suppurativa in most studies.

A 2016 study in JAMA Dermatology found a moderately increased risk of cancer-related mortality in patients with HS. Another Danish study found HS was associated with an 80% higher risk of dying from cancers like digestive organ, lung, breast, and hematological cancers.

There are several potential explanations for the increased cancer mortality rates:

• Smoking - Strongly linked to lung cancer and several other types.
• Chronic inflammation - May promote development of cancers.
• Obesity - Can raise risks for multiple cancers.
• Delayed diagnoses - If HS care delayed, cancers may progress further before catching.

HS patients should follow cancer screening guidelines closely and discuss any new symptoms with their doctor promptly to help detect cancers earlier.

Digestive Diseases

HS patients also appear to have higher mortality rates related to gastrointestinal and liver diseases.

For example, people with HS have been found to have nearly double the risk of dying from digestive organ diseases like gastrointestinal cancers, cirrhosis, pancreatitis, and inflammatory bowel disease.

HS lesions in the groin may contribute to higher risks of developing fistulas, abscesses, and infections near the bowel, genitals, and perianal region. Chronic inflammation can also damage organs.

There are also associations between HS and elevated rates of metabolic syndrome and non-alcoholic fatty liver disease. The systemic inflammation from HS may accelerate damage to the digestive organs.

Respiratory Diseases

Studies have found HS patients have 2 to 4 times higher rates of death from respiratory diseases, especially COPD and pneumonia.

This is likely related to the high smoking rates in the HS population. Smoking is the leading cause of COPD and greatly increases pneumonia risks.

Lung damage from smoking can be extensive in HS patients, as many start smoking at a young age. Smoking also increases the body-wide inflammation that can further tax the respiratory system.

Suicide

Another prominent cause of excess deaths among HS patients is suicide. This highlights the significant mental health impacts of living with a painful, disfiguring skin condition.

In the 2010 JAMA study, suicide mortality rates were found to be 6 times higher in women with HS and over 4 times higher in men compared to the general public.

A meta-analysis in 2020 calculated that HS patients have around a 7 times higher risk of dying from suicide compared to people without HS. Rates of depression in HS patients range from 20-50%.

Seeking psychiatric care and support is important for managing the depression, social isolation, and decreased quality of life often accompanying HS.

Improving Outcomes for HS Patients

While hidradenitis suppurativa does appear to carry increased risks of mortality, death is not an inevitable consequence of the condition. Early recognition and proper treatment can greatly improve prognosis.

Some tips for patients with HS include:

• Quit smoking, as this strongly worsens HS and risks for various life-threatening diseases.
• Reach out for mental health support if needed.
• Attain a healthy weight through diet and exercise tailored to your abilities.
• See a dermatologist promptly if you suspect HS instead of waiting.
• Discuss screenings for cardiovascular disease, cancer, and other complications with your doctor.
• Consistently follow your HS treatment plan.
• Join HS support groups to help cope with the psychological aspects.

With greater awareness and care for HS, patients have a much better chance of living a full lifespan with this condition.

The Bottom Line

Hidradenitis suppurativa, especially more advanced and severe cases, carries an increased risk of mortality compared to the general population. Multiple studies have found HS patients have 30-80% higher mortality rates.

The leading causes of death associated with HS include cardiovascular disease, cancer, respiratory illnesses, suicide, and digestive diseases. The chronic inflammation and pain of HS, high smoking rates, and mental health impacts likely contribute to increased risks.

However, early diagnosis, smoking cessation, weight control, therapy, screenings, and consistent treatment can greatly improve the prognosis for someone living with HS. Working closely with dermatologists and other healthcare providers can help HS patients manage symptoms and complications to extend their longevity.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.