Understanding and raising associated conditions
An overview of the health topics that come up more often in people with HS — keeping routine preventive care clearly apart from symptoms that deserve to be looked at in their own right.
HS involves more than the skin. See what belongs to routine preventive care and which symptoms are worth mentioning.
Living with HS, you can find articles about Crohn’s disease, PCOS, joints or metabolism online quickly enough — but usually only once you already know what to look for. This page turns that around.
It answers one question: which parts of my general health are worth a thought when I have HS, and which of them are already part of ordinary preventive care in Germany?
No account, nothing stored on a server, and no assessment of your answers.
The 2026 European HS guideline names three areas that should be raised at the first visit and then at least once a year — whether or not you have already noticed a symptom.
The European S2k guideline (Part 1) recommends a cardiovascular-risk assessment at the first visit and then at least once a year.
That can include a history-taking conversation, a blood-pressure check and laboratory tests the clinician selects. It does not mean everyone needs the same tests or a referral to cardiology.
HS can have a substantial psychological impact. The guideline recommends addressing mental health at the first visit and then at least once a year.
That means a structured conversation — not an automatic conclusion that HS causes a mental-health condition, and not a questionnaire this page would score.
The guideline recommends assessment for diabetes and endocrine disorders at the first visit and at least once a year.
Which history, examination or laboratory testing is appropriate depends on the individual and is a clinical decision — not something that follows from having HS.
These are routine adult health topics, whether or not you have HS. They are here because they come up repeatedly in HS recommendations — not because anything about you looks unusual.
High blood pressure and other cardiovascular conditions occur more often in groups of people with HS than in comparison groups. That is a group-level association — it says nothing about your own blood pressure.
Blood-pressure measurement is part of the general adult health check-up in Germany anyway, and can be done at almost any GP appointment.
Diabetes is one of the conditions consistently named in comorbidity-assessment recommendations for HS.
Whether laboratory testing is appropriate depends on age and individual risk profile and is a clinical decision — not something that follows from having HS.
Cholesterol and other blood lipids are part of the general cardiovascular assessment that HS recommendations ask clinicians to consider.
In the German health check-up, blood lipids are included from age 35; in younger adults they may be tested where the risk profile makes it appropriate.
In Germany, much of the metabolic and cardiovascular side of this picture is already part of general preventive care.
Official information on the Gesundheits-Check-up · gesund.bund.de (German Federal Ministry of Health)
HS is increasingly understood as a systemic inflammatory condition. In studies of large patient groups, certain metabolic, gastrointestinal, joint and mental-health conditions occur more often than in comparison groups without HS.
These associations are described at group level. They do not mean that an individual with HS has or will develop any of these conditions, and they do not establish a one-way chain of cause and effect.
How often they occur also differs substantially between regions and study populations. That is why you will find no percentages on this page: a figure from a North American clinic cohort says little about your situation in Germany.
The European HS guideline (S2k, Part 1) was updated in 2026 and, for the first time, names concrete timing for part of the comorbidity assessment instead of only listing associated conditions.
For cardiovascular risk, mental health, and diabetes and endocrine disorders, it recommends assessment at the first visit and then at least once a year.
For joints, spine and psoriasis, it recommends assessment at the first visit and at follow-up visits, without a fixed yearly rhythm. For inflammatory bowel disease, assessment stays symptom-triggered — particularly with persistent digestive symptoms or perianal tunnels.
This does not mean every investigation is necessary for every person. It means these topics should come up regularly, rather than only once a symptom is already obvious.
The first question is: is what should routinely be part of preventive care for HS — cardiovascular health, mental health, metabolism — actually being raised at my appointments?
The second question is: are there topics that should stay on the radar at follow-up visits even without acute symptoms — such as joints, spine or other skin changes?
The third question is: do I have symptoms that deserve to be looked at in their own right instead of being filed under HS automatically — such as persistent digestive symptoms? This is not about investigating on suspicion — it is about not letting a symptom pass unmentioned.
Even the updated guideline points to no trials showing that this kind of assessment improves the skin course of HS itself. It describes a clinical assessment of overall health, not a proven benefit for the skin — and whether every person with HS should be screened for every associated condition remains unsettled.
Cardiovascular risk and metabolic or diabetes-related topics are among the best-studied companions of HS. The European HS guideline recommends assessment for them at the first visit and then at least once a year.
In practice that usually means nothing exotic: have your blood pressure measured, know when your last check-up was, and mention at the next appointment that you have HS.
Inflammatory bowel disease, especially Crohn’s disease, is one of the best-established connections in HS. In the perianal area the two conditions can also look similar, which makes them harder to tell apart.
The guideline names persistent digestive symptoms and perianal tunnels specifically as the reason for assessment — not as grounds for routine screening in every person with HS. Persistent diarrhoea, recurrent abdominal pain, blood in the stool or unintended weight loss have many possible causes. What matters is that they get raised rather than quietly attributed to HS.
Inflammatory joint disease, including spondyloarthritis, occurs more often in HS — and so does psoriasis. The guideline recommends keeping both in view at the first visit and at follow-up visits. Inflammatory back pain characteristically eases with movement rather than with rest, and morning stiffness lasts longer.
Those features are not a test and not a diagnosis. They only help to stop persistent symptoms being written off as ordinary muscular strain, or as simply part of HS.
PCOS is described alongside HS more often than expected. Unlike cardiovascular risk or mental health, it is not part of the 2026 guideline's formal table of recurring review — but both conditions can involve skin changes and both are often recognised late, which is what makes the connection practically relevant.
HS on its own is not a reason for hormone testing, though. If changes to your cycle or increased hair growth concern you, that is the reason to raise it — and the clinician decides what is appropriate.
Anaemia occurs more often in people with HS than in comparison groups in pooled research, and persistent fatigue is a common part of living with HS. The two are easy to conflate, but fatigue does not diagnose anaemia, and anaemia is not automatically iron deficiency.
If tiredness feels disproportionate to your usual HS burden, or comes with symptoms such as breathlessness, palpitations or dizziness, that is worth raising in its own right rather than filing it under HS.
Pain, itch and draining wounds can also disrupt sleep, which can add to the exhaustion without being the same thing as anaemia. Both deserve their own explanation rather than a shared one.
Anaemia and iron deficiency with HSSleep and fatigue with Acne Inversa
A larger observational comparison found periodontitis occurring more often in people with HS than in a matched group without HS. A smaller study without a comparison group also described a substantial oral-health burden in an HS clinic population.
That does not mean HS causes periodontitis, that periodontitis causes HS, or that treating your gums improves the skin disease. None of that is established — both are inflammatory conditions, and researchers are currently studying shared mechanisms and risk factors without that amounting to a cause-and-effect chain in either direction.
There is no HS-specific dental check-up interval. Persistent gum bleeding, ongoing gum swelling or recession, loose teeth, or bad breath that does not improve are worth a dental assessment — the same as for anyone, regardless of HS.
The psychological burden of HS is well documented and explicitly included in comorbidity-assessment recommendations. Pain, drainage, odour and the location of affected areas all affect everyday life, work and relationships.
This page deliberately runs no questionnaire and produces no score. It simply records that this belongs in the same appointment as everything else.
Tell your dermatologist if you also have recurrent pilonidal disease, severe acne-like disease elsewhere on the body, or unusual inflammatory ulcers. These associations are recognised and can matter for how your condition is understood.
You will deliberately not find a full list of rare syndromes here. For the great majority of readers it would create more worry than value — and it belongs in a dermatological assessment anyway.
A large part of what this page covers is not a special service at all — it is part of the general preventive care available to people with statutory health insurance in Germany anyway.
The check-up does not replace dermatological treatment of HS and is not an HS screening. It is the place where blood pressure, metabolism and risk profile get discussed regularly.
The HS guideline's recurring-review recommendations are a different system from this check-up: the guideline applies regardless of age, while the check-up has its own age rules. The two complement each other, but neither replaces nor creates an entitlement to the other.
It cannot establish whether you have an associated condition, and it calculates no personal risk. It does not replace a medical examination and recommends no particular laboratory test.
What it can do: show you which topics exist at all, and help you raise two or three of them at your next appointment.
Each of the symptoms below has many possible causes. None of them means a particular condition is present — they are simply worth the sentence “I have noticed this too.”
Worth keeping on the radar at follow-up visits
Inflammatory joint disease, including spondyloarthritis, occurs more frequently in people with HS. The guideline recommends keeping it in view at the first visit and at follow-up visits, without a fixed yearly rhythm. Persistent joint or back symptoms are easily dismissed as ordinary aches and stiffness.
Inflammatory joint disease, including spondyloarthritis, occurs more frequently in people with HS, and the guideline names it explicitly for first and follow-up visits. Persistent symptoms therefore deserve to be looked at in their own right rather than assumed to be ordinary wear and tear. This is not an indication that you have such a condition.
The guideline recommends keeping psoriasis in mind at the first visit and at follow-up visits, alongside HS itself. This is not an indication that you have psoriasis, and no image is shown here for comparison.
Psoriasis is named in its own right for first and follow-up visits in HS comorbidity-assessment recommendations. Such a skin change does not mean you have psoriasis — it is worth being looked at in dermatology in its own right, rather than being filed under HS.
Some checks depend on symptoms or findings
Inflammatory bowel disease, particularly Crohn’s disease, occurs more often in people with HS than in comparison groups. The guideline treats this differently from cardiovascular or mental health: it does not recommend routine assessment for everyone, but names persistent digestive symptoms — and particularly perianal tunnels — as the reason to consider inflammatory bowel disease.
HS is associated with inflammatory bowel disease, particularly Crohn’s disease — the guideline names persistent digestive symptoms and perianal tunnels specifically as the reason to consider it. These symptoms have many possible causes and do not mean you have Crohn’s disease — but they are worth raising rather than attributing everything to HS. Whether any further assessment is appropriate is for your treating clinician to decide.
Other health topics that may matter depending on symptoms
Polycystic ovary syndrome (PCOS) is described alongside HS more often than expected, but it is not part of the 2026 guideline's formal table of recurring review. HS is not an indication of PCOS, though, and this section asks nothing about fertility or family planning.
PCOS is described alongside HS more often than expected — but HS on its own neither establishes a PCOS diagnosis nor makes any particular investigation necessary. If menstrual or androgen-related symptoms concern you, raise them; which assessment is appropriate is for the relevant clinician to decide.
The discussion sheet records what you want to raise in a couple of minutes — and phrases the questions to go with it.
Open the discussion sheetNo. The associations described here apply to groups, not to individuals. Most people with HS do not have all of these conditions — and many have none of them.
No. There is no evaluation, no score and no “positive” or “negative” result. Your selections only produce a list of the points you want to raise yourself.
This page deliberately names none. Which investigation is appropriate depends on age, history, symptoms and risk profile, and is a clinical decision. That is why the discussion sheet is phrased as questions rather than requests.
Either works. Dermatology looks primarily after the skin; routine prevention and many of the topics here typically run through a GP practice. The sheet is written so that it works in both appointments.
No, HS is not a separate entitlement criterion. The general rules apply: once between 18 and 34, and every three years from age 35. You can, however, explicitly mention at the appointment that you have HS.
No. The guideline describes what should routinely be considered in the medical care of people with HS, regardless of age. The German Gesundheits-Check-up is a statutory preventive benefit with its own age rules. The two complement each other, but neither replaces nor creates an entitlement to the other.
No. The guideline names topic areas and approximate timing, not a fixed list of laboratory tests. Which history, examination or laboratory test is appropriate in an individual case is a decision for the treating clinician.
That is not established. Even the updated guideline points to no trials showing that this kind of assessment improves the skin course of HS. It describes a clinical assessment of overall health, not evidence of an effect on the skin disease.
Only in your own browser while you use the page — no account, nothing sent to a server of this website, and no link anyone could open. Reloading clears the sheet, and “Delete my answers” removes it immediately.
Last editorially reviewed: · Next review:
Preventive-care details checked:
That certain metabolic, gastrointestinal, joint and mental-health conditions occur more often in HS is described in clinical recommendations and systematic reviews. These are group-level associations, not statements about individuals.
Reported frequencies differ substantially between regions and study populations. That is why we deliberately quote no percentages here and derive no personal risk from them.
Whether screening every person with HS for every associated condition is worthwhile is not settled. These pages therefore keep routine preventive care and symptom-triggered assessment explicitly apart.
The statements about the German health check-up reproduce official federal information and are re-checked more often than the rest of the text.