Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that extends far beyond painful lesions and abscesses. The condition is associated with significant physical pain, social stigma, depression, and reduced quality of life — burdens that can be especially prevalent among Black Americans, who experience HS at disproportionately higher rates than other racial and ethnic groups.
A study published in JAMA Dermatology suggests that HS is also associated with an increased hazard of self-harm and suicide.
Nikolaj Holgersen, M.D., Ph.D., from Copenhagen University Hospital in Denmark, and colleagues examined the rates of self-harm and suicide and factors associated with suicide in HS. Patients with HS were age- and sex-matched with individuals from the background population in a 1:5 ratio (9,566 patients with HS and 47,827 controls).
The researchers found that 3.3 percent of patients with HS and 1.1 percent of controls had an episode of self-harm (incidence rate [IR] per 1,000 person-years, 4.26). Patients with HS had a higher hazard of self-harm than controls in the adjusted model (hazard ratio, 2.13). The HS group with prior episodes versus without prior episodes of self-harm had a lower hazard of self-harm (hazard ratio, 1.43 versus 2.06) compared with respective control groups. During follow-up, 0.2 and 0.1 percent of patients with HS and controls, respectively, died by suicide (IR, 0.23 versus 0.08 per 1,000 person-years). Patients with HS had a higher hazard of suicide than controls in the adjusted model (hazard ratio, 2.54). Among those who died by suicide, nonviolent methods were more often used by patients with HS (52.9 versus 29.0 percent), and they more often had prior self-harm episodes than controls (41.7 versus 14.8 percent).
“HS was associated with a higher hazard of self-harm overall, although this was attenuated by controls with prior self-harm episodes, who may have a psychiatric burden more equal to that of the HS population,” the authors write.
HS disproportionately affects Black Americans, especially Black women, who are three times more likely to develop the chronic skin condition than white patients. Research has also shown that Black patients are 30 percent more likely to experience delayed diagnosis, greater disease severity, and significant barriers to specialty care access. Because of this, many end up living with chronic pain, recurrent abscesses, drainage, and permanent scarring for years before receiving the proper treatment.
These physical symptoms can significantly affect patients’ mental well-being. The psychosocial burden of HS — including embarrassment, social isolation, missed work, and reduced quality of life— may further compound the increased risk of self-harm identified in the study.
For providers, the findings underscore the importance of considering both the physical and emotional impact of HS, particularly among populations already experiencing disparities in care.
The study’s findings reinforce that mental health should be viewed as a routine component of HS management rather than a separate concern. Screening for depression, anxiety, and suicidal ideation during dermatology or primary care visits can help identify patients who may otherwise go unnoticed — particularly those with severe disease or frequent flares.
Helpful tools such as the Patient Health Questionnaire-9 (PHQ-9) can be incorporated into routine visits. Providers should also be prepared to discuss how HS affects daily functioning, relationships, employment, and overall well-being. Open-ended questions about emotional health can normalize these conversations and help patients feel more comfortable sharing concerns.
HS remains a highly stigmatized chronic condition. Because lesions often occur in intimate areas and may cause drainage or odor, many patients report feeling embarrassed and avoid seeking medical care. In some cases, patients are initially misdiagnosed or mistakenly treated for recurrent infections, delaying appropriate care.
For Black patients, these challenges may be compounded by implicit bias, limited access to specialists, and historical mistrust of the healthcare system. Providers can help reduce these barriers by recognizing the emotional burden of HS, using nonjudgmental, person-centered language, and validating patients’ experiences. Building trust through culturally responsive communication may encourage earlier treatment, improve adherence, and create opportunities to address mental health concerns before they escalate.
The study’s findings reveal the link between HS and self-harm, underscoring the need for providers to look beyond the surface. Because Black patients often experience greater disease severity and delays in diagnosis, routine mental health screenings, culturally responsive communication, and comprehensive treatment approaches should be considered essential components of patient-centered HS care.
As newer therapies, such as JAK1 inhibitors, expand the treatment landscape, addressing both the physical and psychological burden of HS may help improve long-term outcomes for this high-risk population.
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