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PubMed This is a summary of 88 peer-reviewed journal articles Updated
Dermatology

PASH Syndrome: A Patient Guide

At a Glance

PASH syndrome combines painful skin ulcers, severe acne, and suppurative hidradenitis because of an overactive immune response, not poor hygiene or contagion. Care focuses on calming inflammation, treating secondary infections, protecting wounds, and coordinating specialist support.

PASH syndrome is a rare and complex medical condition that can be deeply challenging to navigate, often involving years of searching for answers. The name is an acronym for a “triad” of three conditions that occur together: Pyoderma gangrenosum (painful, enlarging skin ulcers), Acne (often severe nodulocystic or acne conglobata), and Suppurative Hidradenitis (painful lumps and abscesses in areas like the armpits or groin) [1]. While these symptoms can be distressing and visible, receiving a diagnosis of PASH is a critical turning point. It moves you away from the frustration of failed treatments for simple “infections” and toward a strategy that addresses the underlying issue: an immune system that has become dysregulated [2][3].

At its core, PASH is understood to be an autoinflammatory disease, meaning your immune system triggers inflammation and attacks your own healthy skin tissue [4]. Unlike a primary infection, it cannot be caught from others and is not caused by poor hygiene. Instead, the body is thought to produce an excess of inflammatory signals—such as TNF-alpha and Interleukin-1—that draw white blood cells into the skin [4][5]. While secondary bacterial infections can and do occur in these open wounds, the underlying drive of the disease explains why standard antibiotics alone often fail to clear the skin. Management typically requires “cooling down” this overactive immune response through targeted medications, often used off-label, known as biologics and other systemic therapies [6][7].

One of the most important concepts for anyone living with the pyoderma gangrenosum component of PASH to understand is pathergy. Pathergy is a phenomenon where the skin becomes extremely sensitive to trauma [8]. For a subset of patients with PASH, simple skin injuries, surgical incisions, or even aggressive wound cleaning can inadvertently trigger a new flare or cause an existing ulcer to expand [9]. This makes the standard “incision and drainage” of abscesses complicated. However, you should never delay emergency medical care or life-saving surgery for a true, deep infection out of fear of pathergy. Your care must be highly individualized, carefully balancing the need for necessary procedures with the protection of your skin [8][10].

Living well with PASH requires more than just managing skin wounds; it involves caring for the whole person through a multidisciplinary care team [11]. If you experience additional symptoms like joint swelling or severe digestive issues, your team may expand to include rheumatologists and gastroenterologists to ensure you don’t have a related overlapping syndrome [12][7]. Beyond the physical symptoms, the chronic pain and visible nature of the disease can take a significant emotional toll. Mental health support and specialized pain management are vital components of your journey [13][14]. While the path is often long, and evidence for treatments primarily comes from small series and case reports, a coordinated approach offers the best opportunity for healing and long-term stability [2][3].

In this guide

6 chapters

01

Getting Started: Understanding PASH Syndrome

Learn what PASH syndrome means, how pyoderma gangrenosum, acne, and hidradenitis fit together, and how diagnosis and treatment address this rare condition.

02

Identifying the Triad: Symptoms and Warning Signs

Learn how PASH syndrome’s acne, hidradenitis suppurativa, and pyoderma gangrenosum appear, how pathergy works, and when skin changes need urgent medical care.

03

Diagnosis and the Immune System: How PASH Is Identified

Learn how doctors identify PASH syndrome, use Delphi criteria for pyoderma gangrenosum, rule out infections, and distinguish related autoinflammatory syndromes.

04

Modern Management: Treating the PASH Triad

Learn how PASH syndrome is treated, including steroids, biologics, acne therapy, surgery, infection screening, and monitoring for medication risks over time.

05

Protecting Your Skin: Wound Care and Surgical Risks

Learn how PASH syndrome affects wound care and surgery, including pathergy risks, gentle dressings, debridement, pain control, and when to seek specialist help.

06

Building Your Team: Multidisciplinary Care for PASH

Learn how to build a PASH care team, coordinate dermatology and specialty visits, screen for related conditions, prepare for appointments, and manage pain.

Common questions in this guide

What is PASH syndrome?
PASH syndrome is a rare autoinflammatory condition in which pyoderma gangrenosum, severe acne, and suppurative hidradenitis occur together. It is driven by immune-system inflammation rather than poor hygiene or something you can catch from another person.
How is PASH syndrome diagnosed?
Clinicians look for the characteristic combination of painful skin ulcers, severe acne, and hidradenitis while considering related or look-alike syndromes. They also assess whether symptoms reflect an immune flare, a secondary infection, or both.
Can PASH syndrome be caused by an infection?
PASH itself is not a contagious infection and is not caused by poor hygiene. Bacteria can infect open wounds secondarily, but antibiotics alone may not control the underlying immune-driven inflammation.
What does pathergy mean for someone with PASH?
Pathergy means that skin trauma, including an injury, incision, or aggressive wound cleaning, can trigger a new ulcer or make an existing one worse. Procedures should be planned with your care team, but fear of pathergy should not delay emergency care for a true deep infection.
What treatments are used for PASH syndrome?
Treatment often aims to calm the overactive immune response with biologic medicines or other systemic therapies. Care may also include antibiotics for secondary infections, individualized wound care, pain management, and mental health support.
Which specialists may help manage PASH syndrome?
A multidisciplinary team can include clinicians experienced in inflammatory skin disease, rheumatologists, and gastroenterologists when joint or digestive symptoms are present. Pain management and mental health support can also help with chronic pain and the emotional effects of visible disease.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my symptoms, do you believe I have the classic PASH triad or a related 'look-alike' syndrome?
  2. 2.How will we differentiate between an autoinflammatory flare and a secondary infection in my future treatment?
  3. 3.What experience does your clinic have in managing rare autoinflammatory diseases like PASH?
  4. 4.Before we consider any skin procedures or surgeries, how will we ensure my inflammation is controlled while managing any real infections?
  5. 5.Which specific specialists should be part of my core care team based on my symptoms?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (14)
  1. 1

    Pyoderma Gangrenosum, Acne, and Hidradenitis Suppurativa Syndrome: A Case Report and Literature Review.

    Huang J, Tsang LS, Shi W, Li J

    Frontiers in medicine 2022; (9()):856786 doi:10.3389/fmed.2022.856786.

    PMID: 35402426
  2. 2

    Rapid Remission through Multimodal Therapy in a Severe Form of PASH Syndrome: A Case Report.

    Lohmer CB, von Stebut-Marx J, Wilhelm T, et al.

    Case reports in dermatology 2026; (18(1)):256-263 doi:10.1159/000551256.

    PMID: 42256375
  3. 3

    Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndrome: a single-institution case series with a focus on management.

    Yan A, Gallardo M, Savu A, Kaffenberger B

    Archives of dermatological research 2024; (316(7)):397 doi:10.1007/s00403-024-03125-7.

    PMID: 38878169
  4. 4

    Autoinflammation in pyoderma gangrenosum and its syndromic form (pyoderma gangrenosum, acne and suppurative hidradenitis).

    Marzano AV, Damiani G, Ceccherini I, et al.

    The British journal of dermatology 2017; (176(6)):1588-1598 doi:10.1111/bjd.15226.

    PMID: 27943240
  5. 5

    Hidradenitis Suppurativa Is Characterized by Dysregulation of the Th17:Treg Cell Axis, Which Is Corrected by Anti-TNF Therapy.

    Moran B, Sweeney CM, Hughes R, et al.

    The Journal of investigative dermatology 2017; (137(11)):2389-2395 doi:10.1016/j.jid.2017.05.033.

    PMID: 28652108
  6. 6

    Autoinflammatory Syndromes of Hidradenitis Suppurativa: Updates in Clinical Features, Emerging Associations, and Management.

    Ho JY, Liang AL, Maronese CA, et al.

    Current rheumatology reports 2026; (28(1)).

    PMID: 42593626
  7. 7

    Management of Hidradenitis Suppurativa in Special Populations: A Narrative Review.

    Mallela T, Passannante L, Patel H, et al.

    Dermatology and therapy 2025; (15(8)):1985-1998 doi:10.1007/s13555-025-01457-4.

    PMID: 40542230
  8. 8

    Concurrent Hidradenitis Suppurativa and Pyoderma Gangrenosum in a Pediatric Cohort: A Retrospective Case Series.

    Wu V, Lara-Corrales I, Sibbald C, Levy R

    Journal of cutaneous medicine and surgery 2026; (30(2)):139-142 doi:10.1177/12034754251386763.

    PMID: 41189322
  9. 9

    Wound Debridement in Pyoderma Gangrenosum.

    Taheri A, Mansoori P, Sharif M

    Advances in skin & wound care 2024; (37(2)):107-111 doi:10.1097/ASW.0000000000000092.

    PMID: 38241454
  10. 10

    The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience.

    Almeida IR, Coltro PS, Gonçalves HOC, et al.

    Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2021; (29(3)):486-494 doi:10.1111/wrr.12910.

    PMID: 33772964
  11. 11

    Phenotypes and Pathophysiology of Syndromic Hidradenitis Suppurativa: Different Faces of the Same Disease? A Systematic Review.

    Nikolakis G, Kaleta KP, Vaiopoulos AG, et al.

    Dermatology (Basel, Switzerland) 2021; (237(5)):673-697 doi:10.1159/000509873.

    PMID: 32942279
  12. 12

    Whole-Exome Sequencing in 10 Unrelated Patients with Syndromic Hidradenitis Suppurativa: A Preliminary Step for a Genotype-Phenotype Correlation.

    Marzano AV, Genovese G, Moltrasio C, et al.

    Dermatology (Basel, Switzerland) 2022; (238(5)):860-869 doi:10.1159/000521263.

    PMID: 35034021
  13. 13

    The epidemiology of hidradenitis suppurativa.

    Ingram JR

    The British journal of dermatology 2020; (183(6)):990-998 doi:10.1111/bjd.19435.

    PMID: 32880911
  14. 14

    Prevalence of Neuropathic Pain and Related Characteristics in Hidradenitis Suppurativa: A Cross-Sectional Study.

    Garcovich S, Muratori S, Moltrasio C, et al.

    Journal of clinical medicine 2020; (9(12)) doi:10.3390/jcm9124046.

    PMID: 33333779

This page explains PASH syndrome, pathergy, and care options for educational purposes only; it does not replace medical advice. Ask your care team before changing treatment or having a procedure.

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