Although hidradenitis suppurativa (HS) is a skin disease, it can affect the whole body, inside and out. If you have HS, you may experience flu-like symptoms — such as fever, nausea, muscle aches, fatigue, or headaches — even if you don’t have influenza. These symptoms can happen right before or after a flare-up. Medication side effects can also be to blame.

Of course, people with HS also may come down with the flu or illnesses that cause similar symptoms. If you’re not sure why you’re feeling under the weather, here are some scenarios to consider and action steps to take next.

Flu-Like Symptoms Before a Flare

For some people with HS, flu-like symptoms signal that a flare-up is starting. These are called prodromal symptoms — they occur before an inflamed nodule or abscess develops. When researchers gave a questionnaire to 72 people with HS, 23 percent of respondents said they experienced malaise (a feverlike sensation) just before developing an HS lesion. The respondents also reported symptoms including:

• Fatigue — 32 percent
• Headache — 11 percent
• Nausea — 2 percent

Not everyone experiences prodromal symptoms. Keeping a journal to document how you’re feeling and what HS symptoms you have can help you identify patterns to discuss with your health care provider.

Signs of an Infection

Some myHSteam members experienced flu-like symptoms when a skin infection developed after an HS lesion erupted.

“I have a spot that popped, and since then, I’ve had a fever, chills, a migraine, and vomiting. It’s like the flu, but it’s not the flu,” explained a member of myHSteam. “Has anyone had this happen to them? I really don’t want to go to the doctor right now because I know they will cut it open and shove it full of gauze. I can’t handle that right now, but I have never had symptoms like this after it pops. Sometimes I get a fever and pain when it’s about to come to a head. I’m just at a loss.”

Another member responded with words of wisdom based on their experience: “The last time this happened to me, I was told that I had an infection. I know you don’t want to, but it’s probably best to go ahead and find out what’s going on before it’s too late.”

Symptoms like a fever and chills are general, telltale signs of infection. Infections can be a complication of HS. It’s understandable to want to avoid painful procedures or bad news at the doctor’s office. However, ignoring your symptoms can sometimes lead to more serious complications and put you in an emergency situation.

Potential Side Effects of Medication

Several common medications for HS can cause nausea that may be mistakenly attributed to the flu or a stomach bug. These drugs include:

• Antibiotics
• Antidepressants
• Aspirin
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve)

The impact on your stomach can be worse if you’re taking multiple medications at the same time. For unexpected nausea or vomiting, check your medication’s listed side effects and talk with your pharmacist. Sometimes taking pills with food or delaying your dose until right before bedtime can minimize unwanted effects.

However, if you take biologics such as adalimumab (Humira) for HS, it’s important to keep in mind that you may be more likely to catch a cold or the flu. Biologics work by selectively modulating (adjusting) the immune system throughout the body.

You can help protect yourself against influenza by getting an annual flu shot. But some flu vaccines, such as the nasal spray, use live viruses, which are off-limits for people taking immunosuppressants. Be sure to tell your pharmacist or health care provider about all your medications, and only get flu vaccines that are safe for you. If you’re taking an immunosuppressant for HS and develop a fever or other flu-like symptoms, let your provider know right away so you can be treated and monitored to avoid more serious illnesses, like pneumonia.

Comorbidities and Complications

Many other common issues can produce symptoms similar to the flu. For example, food poisoning can cause vomiting, diarrhea, and fever, and seasonal allergies can give you a cough, headache, or runny nose. You can even have chills from dehydration or fatigue from lack of sleep.

Aside from trying to follow a healthy lifestyle, people with HS should be on the lookout for potential comorbidities (coexisting conditions). Chronic inflammation is an underlying link between HS and many other conditions, such as heart disease, diabetes, and certain types of arthritis, cancer, and digestive diseases. If you’re only focused on treating your HS, it’s easy to get tunnel vision and forget to pay attention to other aspects of your health. Flu-like symptoms could be related to changes in blood sugar or other problems you didn’t know about. That’s why it’s so important to communicate your symptoms to your health care team and speak up if you feel like you’re not getting the answers you need.

Prevention and Management

Learning the cause of your flu-like symptoms is the first step toward feeling better. For instance, if you notice a pattern between feeling unwell and developing an HS lesion, you’ll be more prepared for what’s to come. At the first sign of fever or fatigue, do your best to reduce stress, wear comfortable clothing, and take good care of your skin. If possible, keep your upcoming schedule flexible so you don’t feel pressured if a flare shows up on your doorstep.

If you’re prone to flu-like symptoms after an abscess ruptures, you may need to rethink wound care strategies for HS lesions. Take extra precautions to avoid infection by following your dermatologist’s medical advice. Some cysts should be drained in the doctor’s office, and others may need to be treated with steroid medications or antibiotics. Flu-like symptoms after a lesion opens up should be discussed with your health care provider to keep a potentially dangerous infection from getting worse.

Discuss any concerns about medication side effects or comorbidities with your doctor. Even a simple fix, like taking your medications with food, could help. If flu-like symptoms suggest a separate health condition, you may need blood work or other tests to find out what’s going on. Catching problems early gives you the best chance of taking control of your health and your future.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 33,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Have you experienced flu-like symptoms when you also had symptoms of HS? What other ways has your skin condition affected your quality of life? Share your experience in the comments below, or start a conversation by posting on your Activities page.