Hidradenitis suppurativa (HS) is a painful skin condition that causes recurrent boils, drainage, and scarring in areas like armpits and groin. This Dutch study surveyed over 167,000 people and found that HS is more common than previously thought (2% rather than 1%), and that people with HS often have other conditions including chronic fatigue syndrome, fibromyalgia, and depression. The study also found that many people with HS have not yet been diagnosed or treated.
Why It Matters
This study is important for ME/CFS patients and researchers because it identifies chronic fatigue syndrome as a significantly more common comorbidity in people with HS, suggesting a potential shared pathophysiological pathway or overlapping patient population. Understanding these disease associations may help researchers identify common mechanisms of immune dysfunction and inform clinical screening practices. The high rate of undiagnosed cases highlights how poorly understood inflammatory conditions—including those affecting ME/CFS populations—remain in clinical practice.
Observed Findings
HS prevalence was 2% in the surveyed Northern Netherlands population, higher than the anticipated 1%.
A substantial proportion of people with HS had not yet received a diagnosis or treatment.
Chronic fatigue syndrome, fibromyalgia, and migraine were more frequently reported in people with HS than in the general surveyed population.
Known associations between HS and obesity, type 2 diabetes, COPD, depression, and Crohn's disease were confirmed.
Smoking was more common in people with HS.
Inferred Conclusions
HS is more prevalent in the general population than previously estimated, and many cases remain clinically unrecognized.
People with HS have a higher burden of multiple chronic comorbidities, particularly pain-related and psychiatric conditions.
Clinicians should be alert to the possibility of HS in patients presenting with multiple unexplained symptoms, particularly those with fibromyalgia, chronic fatigue, or migraine.
Remaining Questions
Is the association between HS and chronic fatigue syndrome mechanistically related through shared immune or inflammatory pathways, or do both conditions share common risk factors?
What proportion of the undiagnosed HS cases would benefit from early intervention, and how does diagnostic delay affect disease progression and comorbidity development?
What This Study Does Not Prove
This study does not establish causation between HS and associated conditions like chronic fatigue syndrome; the cross-sectional design only demonstrates correlation at a single timepoint. The self-report questionnaire methodology means diagnoses were not confirmed by medical evaluation, which may introduce recall bias and misclassification. The study does not clarify whether comorbidities are mechanistically related to HS pathophysiology or arise from shared risk factors such as smoking and lifestyle factors.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →