Hidradenitis suppurativa and COVID-19 are two very different health topics that somehow manage to meet in the same awkward waiting room. One is a chronic inflammatory skin condition that causes painful lumps, abscesses, drainage, tunnels, and scarring. The other is a viral respiratory infection that has rewritten everyone’s relationship with hand sanitizer, home tests, and suspicious coughs in grocery stores.
So, what happens when you have hidradenitis suppurativa, often shortened to HS, and you are worried about COVID-19? Does HS make COVID more dangerous? Can COVID trigger an HS flare? Should you stop biologics, antibiotics, or other HS medications if you test positive? And what about COVID vaccinesfriend, foe, or dramatic supporting character?
The short answer: hidradenitis suppurativa itself is not generally considered a direct cause of severe COVID-19. However, many people with HS have related health factorssuch as obesity, smoking, diabetes, metabolic syndrome, depression, chronic inflammation, or immune-modifying medicationsthat can affect COVID risk, recovery, and day-to-day disease management. In other words, HS may not be the villain, but it may be standing near the plot twist.
This guide explains what people with hidradenitis suppurativa should know about COVID-19, including risk factors, flares, vaccines, treatment planning, prevention, and practical everyday tips.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa is a chronic, noncontagious inflammatory skin disease. It usually develops in areas where skin rubs together or where hair follicles and sweat glands are common, such as the armpits, groin, buttocks, inner thighs, under the breasts, and around the genitals. It is not caused by poor hygiene, and no, scrubbing harder is not the solution. Your skin is not a dirty pan.
HS often begins with tender bumps that may look like boils, acne, or ingrown hairs. Over time, these bumps can become painful abscesses, rupture, drain fluid, form tunnels under the skin, and leave scars. Many people go years before getting the correct diagnosis because HS can be mistaken for common infections or “just bad acne.”
Common HS Symptoms
Symptoms vary from person to person, but hidradenitis suppurativa may include recurring painful lumps, blackhead-like spots, abscesses, drainage, odor, itching, burning, fatigue, scarring, and restricted movement when lesions appear in high-friction areas. Flares may come and go, sometimes with the predictability of a cat knocking things off a shelf.
HS Is an Inflammatory Condition
HS is linked to immune system activity and inflammation. That does not mean every person with HS is “immunocompromised.” It means the immune system is involved in the disease process. Some HS treatments, especially biologic medications and systemic steroids, can affect immune responses, which is why COVID-19 questions often come up during dermatology visits.
Does Hidradenitis Suppurativa Increase the Risk of Getting COVID-19?
Current evidence does not show that hidradenitis suppurativa by itself makes someone more likely to catch COVID-19. COVID-19 spreads mainly through respiratory particles when infected people breathe, talk, cough, or sneezeespecially in crowded indoor spaces with poor ventilation. HS lesions do not transmit COVID-19, and HS is not contagious.
However, risk is personal. A person with mild HS, no other major health conditions, and no immune-suppressing medications may have a different COVID risk profile than someone with severe HS, diabetes, obesity, smoking history, and frequent steroid use. The diagnosis matters, but the full medical picture matters more.
Why People With HS May Still Need Extra COVID Awareness
HS often travels with other health conditions. Not always, of courseHS is not a subscription bundlebut the overlap is common enough that it deserves attention.
Comorbidities Can Raise COVID Risk
Some conditions linked with HS are also associated with a higher risk of severe COVID-19. These may include obesity, type 2 diabetes, high blood pressure, cardiovascular disease, smoking-related lung problems, kidney disease, and immune compromise. People over age 50, and especially those over 65, also face higher risk from COVID-19 complications.
This does not mean panic is the plan. Panic has terrible bedside manner. It means people with HS should know their personal risk factors and talk with their healthcare provider about vaccination, early testing, antiviral treatment eligibility, and prevention strategies.
Chronic Inflammation Can Complicate the Picture
HS is more than a skin problem. Moderate-to-severe HS can involve systemic inflammation, pain, sleep disruption, stress, and mental health strain. During a COVID infection, the body is already dealing with viral inflammation and immune activation. For some people, that extra stress may coincide with HS flares or slower recovery.
Can COVID-19 Trigger an HS Flare?
Some people report HS flares after COVID-19 infection. Research is still developing, and not every study points in the same direction. That is normal in medicine; science often arrives wearing one shoe and carrying a clipboard.
Several possible reasons may explain why COVID-19 could be followed by an HS flare:
- Immune activation: Viral infections can activate inflammatory pathways that may worsen inflammatory skin diseases.
- Fever and sweating: More heat, sweating, and friction can irritate HS-prone areas.
- Stress: Illness, isolation, missed work, and anxiety can trigger or worsen flares in some people.
- Routine disruption: During COVID, people may skip showers, wound care, medications, exercise, or dermatologist visits because they feel awful.
- Medication changes: Stopping HS treatment suddenly may increase the chance of symptoms returning.
If you notice an HS flare during or after COVID-19, document the timing, location, severity, drainage, fever, and pain level. This information helps your dermatologist decide whether you need wound care, antibiotics, steroid injections, medication adjustments, or an in-person evaluation.
Can COVID Vaccines Cause HS Flares?
Some people with HS have reported flares after COVID vaccination. Small studies and case reports have discussed this possibility, but the overall evidence does not prove that vaccination consistently causes HS worsening in most patients. A flare after vaccination can happen, but that does not mean every person with HS should avoid vaccines.
Vaccines stimulate the immune system. That is the pointbasically, your immune system gets a training montage. In some people with inflammatory conditions, immune stimulation may temporarily coincide with symptoms such as fatigue, soreness, fever, or disease flare. Still, for many people, the protection against severe COVID-19 is more important than the possibility of a temporary HS flare.
The best approach is individualized. If you have a history of severe vaccine-related flares, are taking immune-modifying therapy, are pregnant, have multiple medical conditions, or have had serious vaccine reactions in the past, talk with your doctor before your next dose. Do not make medication decisions based only on internet comments, even if the comments use confident punctuation.
Should People With HS Get COVID-19 Vaccines?
Most people with hidradenitis suppurativa can receive COVID-19 vaccination, but recommendations may depend on age, medical conditions, immune status, medication use, and current public health guidance. People who are moderately or severely immunocompromised may have different vaccine timing or dose recommendations than the general population.
If you take biologics such as adalimumab, secukinumab, or bimekizumab, ask your dermatologist whether your vaccine schedule should be adjusted. Many patients continue treatment as planned, but some clinicians may personalize timing depending on disease severity, infection history, and medication type.
Do not stop HS medication before vaccination unless your healthcare provider tells you to do so. Stopping suddenly may cause a flare that is far more annoying than the arm soreness you were trying to avoid.
HS Medications and COVID-19: What to Ask Your Doctor
HS treatment can include topical washes, topical antibiotics, oral antibiotics, hormonal therapy, retinoids, biologics, corticosteroids, pain management, laser therapy, deroofing, excision, and other procedures. The right treatment depends on disease severity and personal health history.
Biologics
Biologic medications target specific parts of the immune system. In HS, approved biologic options may include adalimumab for some adolescents and adults, secukinumab for adults, and bimekizumab for adults with moderate-to-severe disease. These medications can reduce inflammation and improve quality of life, but they may also affect infection risk in some patients.
Available HS registry data have not shown that biologic therapy automatically leads to worse COVID-19 outcomes in people with HS. That is reassuring, but it does not mean everyone has the same risk. Your doctor may consider your age, other conditions, vaccine status, COVID severity, and whether you currently have symptoms.
Antibiotics
Antibiotics are commonly used for HS because they can reduce bacteria and inflammation. Common options may include doxycycline, clindamycin, rifampin combinations, or other regimens. Antibiotics do not prevent COVID-19 because COVID is caused by a virus, not bacteria. Taking leftover antibiotics for COVID is not a clever shortcut; it is more like bringing a lawn mower to a sushi restaurant.
Corticosteroids
Steroids may be used in certain HS situations, such as injections into inflamed lesions or short-term systemic treatment. Long-term or high-dose systemic steroids can suppress immune function and may raise infection concerns. If you test positive for COVID-19 while taking steroids, contact your healthcare provider before stopping or changing the dose.
When You Test Positive for COVID-19
If you have COVID-19 and take immune-modifying HS medication, contact your dermatologist or primary care provider. Some medications may be paused temporarily during active infection, while others may be continued. The decision should be made by a clinician who knows your HS severity and overall health.
You should also ask whether you qualify for antiviral COVID treatment. For high-risk patients, treatment works best when started earlyoften within the first five days of symptoms for oral antiviral options. Do not wait until day seven to begin thinking about treatment. COVID antivirals are not dramatic movie heroes; they do their best work when called early.
How to Reduce COVID Risk When You Have HS
COVID prevention for people with HS is not wildly different from prevention for everyone else, but it may deserve more planning if you have additional risk factors.
Stay Current on Vaccines
Ask your healthcare provider which COVID vaccine schedule applies to you. Also ask about flu, RSV, pneumonia, shingles, and other vaccines if relevant. Respiratory viruses love arriving as a group project, and nobody asked for that collaboration.
Use Masks Strategically
High-quality, well-fitting masks such as N95 or KN95 respirators can reduce exposure in crowded indoor spaces, healthcare settings, airports, public transportation, and poorly ventilated rooms. You may not need one everywhere, but keeping a mask available is practical, especially during surges or before surgery, travel, or important events.
Improve Ventilation
COVID spreads more easily indoors when air is stagnant. Open windows when possible, use air filtration, meet outdoors when reasonable, and avoid crowded indoor spaces when community spread is high.
Test Early
If you develop symptoms such as fever, cough, sore throat, congestion, fatigue, headache, body aches, or sudden loss of taste or smell, test for COVID-19. If your first test is negative but symptoms continue, repeat testing may be useful. Early diagnosis matters if you may qualify for antiviral treatment.
Have a Medication Plan Before You Get Sick
If you take biologics, steroids, or other immune-modifying medication, ask your doctor in advance: “What should I do if I test positive for COVID?” Write the answer down. Future sick-you will appreciate present organized-you.
Managing HS During COVID Isolation
Being sick at home can disrupt HS care. Try to keep the basics simple and realistic. You do not need a spa routine with flute music and cucumber water. You need clean skin, reduced friction, pain control, and a plan.
Keep Gentle Skin Care Going
Use a gentle cleanser or antiseptic wash if your dermatologist recommended one. Avoid aggressive scrubbing, harsh fragrances, and tight clothing. Pat skin dry instead of rubbing. Choose breathable, loose fabrics to reduce friction in flare-prone areas.
Use Warm Compresses
Warm compresses may help ease tenderness and encourage drainage in some HS lesions. Use clean cloths and avoid burning the skin. If a lesion becomes increasingly red, hot, swollen, extremely painful, or associated with fever, seek medical advice.
Protect Draining Areas
Use appropriate dressings to absorb drainage and reduce friction. Change dressings regularly and wash your hands before and after wound care. If supplies are running low, pharmacies, online medical supply stores, or your clinic may be able to help.
Do Not Pop Lesions
Squeezing HS bumps may worsen inflammation, damage tissue, increase pain, and raise infection risk. It is tempting, yes. So is eating cake for breakfast. Tempting does not always equal wise.
When to Call a Doctor
Call your healthcare provider if you have COVID-19 and are at higher risk for severe illness, take immune-modifying medication, have worsening shortness of breath, chest pain, confusion, dehydration, persistent high fever, or oxygen concerns.
For HS specifically, contact your dermatologist if you have rapidly worsening pain, spreading redness, fever, foul drainage, new tunneling, inability to walk or move normally, lesions near the genitals or rectum that are worsening, or flares that do not improve with your usual plan.
Practical Experiences: Living With HS in the COVID Era
Many people with hidradenitis suppurativa describe the COVID era as a strange mix of relief, frustration, and “well, this is new.” On one hand, remote work and telehealth made life easier for some patients. Fewer commutes meant less sweating, less friction, and fewer awkward moments trying to manage drainage in public. For someone with painful inner-thigh or groin flares, skipping a long drive or crowded subway ride could feel like a small miracle wearing sweatpants.
On the other hand, the pandemic disrupted routines that help keep HS under control. Dermatology appointments were delayed. Procedures were postponed. Some people lost access to wound care supplies, insurance coverage, or regular prescriptions. Stress increased, sleep suffered, movement decreased, and comfort eating became an Olympic sport in many households. Since stress, friction, sweating, weight changes, and delayed treatment can all affect HS, it is easy to understand why some patients felt their skin became more unpredictable.
One common experience was medication anxiety. A person taking a biologic for HS might wonder, “Am I more vulnerable to COVID?” Then, after getting vaccinated, the same person might wonder, “Will the vaccine work if I am on this medication?” Then, after reading three alarming social media posts, they might wonder, “Should I stop everything and live inside a bubble?” The most helpful pattern was usually not fear-based stopping and starting, but planned communication with a dermatologist. Patients who had a written planwhat to do during infection, when to delay a dose, when to restart, and when to calloften felt more in control.
Another lesson was the value of telemedicine, with limits. Video visits worked well for medication follow-ups, prescription refills, and general flare discussions. But HS is visual and physical. A camera cannot always show tunneling, drainage, odor, scarring, or the true depth of pain. Many patients learned to take clear photos in good lighting, track symptoms, and describe pain honestly. “It hurts” is useful; “It hurts so much I cannot sit, walk normally, or sleep” is even more useful.
People also became more aware of the emotional side of HS. Isolation can make a stigmatized condition feel even heavier. HS already carries embarrassment for many patients because of drainage, odor, intimate body areas, and misconceptions about hygiene. COVID isolation sometimes amplified that loneliness. Support groups, therapy, trusted friends, and patient communities helped many people realize they were not “gross” or “lazy” or “doing skin wrong.” They had a real inflammatory disease that deserved real care.
The biggest practical takeaway is this: living with hidradenitis suppurativa and COVID concerns is not about choosing between skin care and infection prevention. It is about building a flexible plan. Keep vaccines and treatments personalized. Test early when sick. Ask about antivirals if you are high-risk. Maintain wound care supplies. Reduce friction. Keep appointments when possible. And please, do not let shame make medical decisions for you. Shame is loud, but it has no dermatology degree.
Conclusion
Hidradenitis suppurativa and COVID-19 can overlap in complicated ways, but the main message is reassuring: HS itself does not appear to automatically make someone more likely to catch COVID-19 or develop severe disease. The bigger concern is the whole-person pictureother medical conditions, smoking, weight, diabetes, immune status, medications, vaccine history, and access to timely care.
People with HS should not stop treatment out of fear without medical advice. Biologics, antibiotics, hormonal treatments, procedures, and wound care all have a place in HS management, and sudden changes can lead to painful flares. If COVID-19 enters the chat, contact your healthcare provider early, especially if you are high-risk or take immune-modifying therapy.
The best strategy is practical, not panicked: stay informed, keep your HS care plan updated, test early, ask about COVID treatment if needed, and protect your skin from friction, stress, and neglect. HS is already enough of a drama queen. With the right plan, COVID does not need to steal the spotlight.
Note: This article is for educational purposes only and should not replace medical advice from a dermatologist, primary care clinician, or infectious disease specialist. COVID-19 guidance and vaccine recommendations can change, so readers should confirm current recommendations with a qualified healthcare professional.
