Pet Therapy May Offer Support Beyond the Skin in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) extends far beyond the physical manifestations of nodules, abscesses, drainage, and scarring. The chronic and often unpredictable nature of the disease can profoundly affect patients’ mental health, social lives, relationships, and overall quality of life.

For some patients, comprehensive HS management may therefore require attention not only to inflammatory disease activity, but also to the psychological and day-to-day burdens that accompany it.

A recent patient experience in my practice highlighted an unconventional source of support: pet ownership.

A Long Road to Diagnosis and Disease Control

A 31-year-old woman presented to my clinic with uncontrolled HS after experiencing symptoms for approximately 15 years before receiving a diagnosis. Her medical history included polycystic ovarian syndrome, thyroid disease, obesity, depression, anxiety, herpes simplex virus, and attention-deficit/hyperactivity disorder.

She reported recurrent, painful nodules and abscesses involving the axillae, breasts, upper thighs, and buttocks, often accompanied by drainage and significant disruption to daily life.

The patient had previously used topical clindamycin and had received adalimumab for approximately 1 year without what she considered meaningful improvement.

Her treatment plan included topical clindamycin, benzoyl peroxide wash, gentle cleansers and moisturizers, supportive skin care, and lifestyle counseling. After discussing additional therapeutic options, she initiated secukinumab 300 mg subcutaneously every 4 weeks. Although she experienced improvement, breakthrough nodules continued, particularly during warmer weather and periods of increased perspiration. Her dosing frequency was subsequently increased, with further improvement in flares.

Her care also involved other specialties to address comorbid conditions, reflecting the multidisciplinary approach frequently required for patients with HS.

An Unexpected Change

At a later follow-up appointment, the patient appeared noticeably more positive and energetic.

When asked what had changed, she explained that she had recently adopted a dog after unexpectedly connecting with one at an event featuring shelter animals.

She described the adoption as having a substantial impact on several areas of her life, including her anxiety, depression, pain, self-confidence, physical activity, and her overall experience of living with HS.

“The dog gives me energy,” she said.

Having a dog encouraged her to leave the house and exercise more frequently. She also reported feeling more comfortable walking in public because she felt that others were focused on the dog rather than on her.

The emotional benefit was equally meaningful. During painful flares or difficult mental health days, caring for the dog provided structure and motivation.

“The dog is my security blanket,” she said. “The dog doesn’t care or judge me.”

She explained that even on difficult days, she still had a reason to get up, feed the dog, and go outside for a walk.

The Psychological Burden of HS

The experience is particularly relevant given the substantial psychosocial burden associated with HS.

Patients can experience chronic pain, pruritus, drainage, odor, and unpredictable flares, all of which may affect relationships, employment, self-confidence, and social participation. Mental health comorbidities are also common. Depression and anxiety occur at higher rates among individuals with HS than in the general population, and studies have identified an increased risk of suicidal ideation and suicide among patients with the disease.

These findings reinforce the importance of approaching HS as more than an inflammatory skin disorder.

Clinicians should remain attentive to patients’ mental health, ask about the emotional and social effects of disease, and consider multidisciplinary care when appropriate.

Where Could Animal-Assisted Support Fit?

Animal-assisted therapy (AAT), sometimes referred to as pet therapy, uses interactions with animals to support emotional, psychological, and physical well-being. Related approaches can include structured AAT programs, animal-assisted activities, equine-assisted therapy, emotional support animals, service animals, and ordinary pet ownership.

Research outside of HS has suggested that interaction with animals may help reduce stress and anxiety, promote relaxation and social connection, and provide individuals with a greater sense of routine and purpose.

Animal interaction has also been associated with physiologic effects such as reductions in stress responses and increases in oxytocin, a hormone involved in social bonding and emotional regulation.

For patients with chronic illness, pets may provide another benefit that can be difficult to quantify: consistent companionship without judgment.

One study examining pet ownership among individuals managing long-term health conditions found that pets could offer a dependable form of emotional support while also contributing to feelings of purpose and social connection.

These potential benefits may be particularly relevant to HS, where pain, embarrassment, unpredictable flares, and concerns about odor or drainage can contribute to isolation.

Supporting Activity, Routine, and Pain Management

Pet ownership may also indirectly encourage behaviors that benefit overall health.

Dogs, for example, require regular activity, which may encourage patients to walk more frequently and spend additional time outdoors. In this case, the patient specifically identified increased exercise as one of the major changes following adoption.

Animal-assisted interventions have also been explored as supportive approaches for patients experiencing acute and chronic pain. Proposed mechanisms include distraction from pain, emotional comfort, reduced stress, improved sleep, and increased engagement in meaningful activities.

Importantly, these approaches should not be interpreted as treatments for the inflammatory mechanisms underlying HS.

Rather, they may represent one component of a broader supportive-care strategy aimed at addressing the physical and psychological burden of chronic disease.

The dog is my security blanket, the dog doesn’t care or judge me.

Pet Therapy Is Not Appropriate for Every Patient

Pet ownership also carries significant responsibilities and should not be recommended indiscriminately.

Patients considering an animal should take into account allergies, financial costs, housing restrictions, the physical demands of caring for the animal, and the long-term commitment involved.

For patients who are interested in animal interaction but unable to adopt a pet, alternatives may include visiting animals belonging to friends or family members, volunteering with an animal organization, pet-sitting, or participating in established animal-assisted activity programs.

Service animals represent a separate category and undergo specialized training to perform specific tasks for individuals with disabilities. For some patients with severe physical limitations during HS flares, appropriately trained service animals may potentially assist with tasks such as retrieving items or supplies, although individual circumstances and eligibility requirements vary.

Looking Beyond Disease Activity

This case does not establish that pet ownership or animal-assisted therapy directly improves HS disease activity. The patient was receiving medical treatment concurrently, including biologic therapy, and her experience represents a single case.

What it does illustrate is the importance of asking patients what helps them function, cope, and maintain quality of life while living with a chronic and often debilitating disease.

HS management frequently requires individualized combinations of medical therapy, procedural treatment, wound care, pain management, lifestyle support, mental health care, and management of associated comorbidities.

For some patients, supportive interventions that foster routine, physical activity, social connection, confidence, and emotional well-being may provide meaningful additional benefit.

The human-animal bond may be one such tool.

As clinicians, treating HS means addressing more than lesions alone. It means recognizing the person living with the disease and remaining open to supportive strategies that may help patients feel more connected, capable, and supported throughout their treatment journey.

References

1. Caccavale S, Tancredi V, Boccellino MP, et al. Hidradenitis suppurativa burdens on mental health: A literature review of associated psychiatric disorders and their pathogenesis. Life (Basel). 2023;13(1):189. doi:10.3390/life13010189. Pet THerapy HS Article 1024
2. Reeves D, et al. Creature comforts: Personal communities, pets and the work of managing a long-term condition. Chronic Illn. 2012. doi:10.1177/1742395312452620. Pet THerapy HS Article 1024
3. Pandey A. Essentials of hidradenitis suppurativa: A comprehensive review of diagnostic and treatment perspectives. Ann Med Surg (Lond). 2024;86(9):5304-5313. doi:10.1097/MS9.0000000000002345