Hidradenitis Suppurativa and Psoriasis: What is the link?

Hidradenitis suppurativa and psoriasis: Living with just one chronic skin condition can feel like running a marathon you never signed up for — exhausting, unpredictable, and mentally taxing. But for some, the challenge doesn’t end there. Imagine managing not just one, but two persistent inflammatory skin diseases at the same time. This is the reality for people who experience both hidradenitis suppurativa (HS) and psoriasis — a combination that adds a whole new level of complexity to daily life.

At first glance, these two conditions may seem unrelated. HS typically affects skin folds and causes painful, boil-like lesions, while psoriasis is often associated with red, scaly patches and an overactive immune system. Yet, emerging research shows a fascinating — and medically important — link between them.

Studies suggest the relationship goes beyond coincidence:

• People with psoriasis have an 80% higher risk of developing HS compared to those without psoriasis.
• Individuals with HS are 2.67 times more likely to have psoriasis than the general population.

This connection matters. When doctors recognize the possibility of both conditions occurring together, it can lead to earlier diagnoses, better treatment planning, and improved quality of life for patients.

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Understanding Hidradenitis Suppurativa (HS)

Hidradenitis suppurativa is not your typical skin condition. It’s a chronic, inflammatory, and often painful disorder that primarily strikes where skin rubs against skin. While it can technically develop anywhere there are hair follicles, it most often affects:

• Armpits
• Groin
• Inner thighs
• Under the breasts
• Around the buttocks

What HS Looks and Feels Like

HS can be unpredictable and extremely uncomfortable. Typical symptoms include:

• Painful, pimple-like lumps that may progress into deep, inflamed nodules.
• Recurring boils or abscesses that can burst and drain fluid, pus, or blood.
• Sinus tracts — tunnel-like formations under the skin that connect multiple lesions.
• Thick scarring in previously inflamed areas.
• Constant pain, tenderness, and swelling during flare-ups.

Globally, HS affects an estimated 0.00033% to 4.1% of the population — with about 0.7% to 1.2% in the U.S. and Europe. It typically begins after puberty, often in the late teens or early twenties, and is more common in women.

The Impact Beyond the Skin

The physical discomfort is just part of the story. HS can have profound emotional and psychological effects. Because flare-ups are unpredictable and sometimes disfiguring, people often experience:

• Anxiety and depression
• Fear of public outings or intimacy
• Lower self-esteem and self-image issues
• Difficulty maintaining relationships or careers

For many, HS is not just a medical problem — it’s a daily emotional battle.

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Psoriasis: An Overactive Immune System at Work

Psoriasis is one of the most common autoimmune skin conditions, affecting around 3% of U.S. adults. Unlike HS, psoriasis is not caused by blocked hair follicles or bacterial activity. Instead, it’s the immune system mistakenly attacking healthy skin cells, leading to rapid cell turnover and visible skin changes.

Recognizing Psoriasis Symptoms

Psoriasis symptoms can vary in severity but often include:

• Red, inflamed patches covered with silvery-white scales.
• Dry, cracked skin that can bleed or become sore.
• Itching, burning, or pain in affected areas.
• Thickened or pitted nails (nail psoriasis).
• Joint pain or stiffness in some cases, which may indicate psoriatic arthritis.

Psoriasis can appear almost anywhere, but common sites include:

• Scalp
• Elbows
• Knees
• Lower back

The disease usually follows a cyclical pattern, with flare-ups alternating with periods of remission.

Different Types of Psoriasis

There are several variations of psoriasis:

• Plaque psoriasis — the most common form, causing thick, scaly patches.
• Guttate psoriasis — small, drop-shaped sores, often after infections.
• Palmar-plantar pustulosis — pustules appearing on the palms and soles.

Interestingly, research suggests 9% of HS patients also have plaque psoriasis, while 11% have palmar-plantar pustulosis, indicating a notable overlap.

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The Connection Between HS and Psoriasis

The co-occurrence of HS and psoriasis is not random. Scientists believe they share similar biological and environmental triggers, even though their outward symptoms are quite different.

Statistical Evidence for the Link

A major 2022 systematic review of more than 560,000 participants found that HS patients were significantly more likely to develop psoriasis. Likewise, a large-scale population study of nearly 69,000 psoriasis patients revealed an 80% increased risk of HS.

Possible Biological Explanations

• Inflammatory Pathways — HS mostly involves innate immunity (the body’s first line of defense), while psoriasis is driven by adaptive immunity. However, they share some overlapping inflammatory signals.
• Genetic Factors — Some families carry genetic traits that make them more likely to develop both conditions.
• Environmental Triggers — Stress, certain medications, smoking, and obesity can worsen both HS and psoriasis.

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Shared Risk Factors and Genetic Overlap

Understanding what HS and psoriasis have in common helps explain why they often show up together.

Common Risk Factors

• Family history — Genetics are a strong predictor for both diseases.
• Smoking — Tobacco use not only increases the risk but also makes symptoms worse and treatment less effective.
• Obesity — Excess weight can fuel inflammation, making flare-ups more frequent.
• Hormonal changes — Many women report worsening HS symptoms during menstruation, pregnancy, or menopause, which can also influence psoriasis.

Emerging Genetic Insights

Recent studies suggest both HS and psoriasis may share certain immune-related genetic markers. Although they each have unique genetic profiles, some overlap appears in genes that regulate inflammation and immune responses. This could be the missing puzzle piece explaining why one condition often increases the risk of developing the other.

Management and Treatment Approaches for HS and Psoriasis

When someone is diagnosed with both hidradenitis suppurativa and psoriasis, treatment can’t simply be about addressing each disease in isolation. A comprehensive, coordinated plan is essential to control inflammation, reduce flare-ups, and improve overall well-being.

Treating Hidradenitis Suppurativa

1. Topical Treatments
For mild HS cases, doctors may start with topical antibacterial washes or prescription creams. These help reduce bacterial growth on the skin and prevent secondary infections. Zinc pyrithione and chlorhexidine washes are often recommended for daily use.

2. Oral Medications
Moderate to severe HS often requires stronger interventions, such as oral antibiotics to calm inflammation and prevent recurring abscesses. In women, hormonal therapy (like birth control pills or spironolactone) can help if symptoms are tied to menstrual cycles.

3. Biologic Therapies
The biologic drug adalimumab (Humira) is the only FDA-approved medication specifically for HS. It works by targeting TNF-alpha, a protein that fuels inflammation.

4. Surgical Options
In stubborn or advanced HS, procedures like incision and drainage, laser hair removal, or wide excision of affected skin can offer relief. While surgery can’t “cure” HS, it can help reduce the frequency and severity of flare-ups.

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Treating Psoriasis

1. Topical Therapies
First-line treatments often include corticosteroid creams, vitamin D analogs (like calcipotriol), or coal tar ointments. These help slow cell turnover, reduce scaling, and soothe irritation.

2. Light Therapy (Phototherapy)
Controlled UVB light exposure can calm the overactive immune response in psoriasis, often leading to fewer lesions and longer remission periods.

3. Systemic Medications
For moderate to severe psoriasis, oral drugs like methotrexate or cyclosporine may be prescribed. Newer oral treatments, such as JAK inhibitors, target specific immune pathways with promising results.

4. Biologics
Psoriasis biologics often target IL-17 or IL-23 pathways — the same immune signals linked to HS in some cases. Medications like secukinumab or guselkumab can improve skin clearance and, in some patients, reduce HS symptoms as a side effect.

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Coordinated Care Matters

Managing both conditions together requires close communication between dermatologists and other specialists. Key considerations include:

• Avoiding drug interactions when prescribing for both diseases.
• Monitoring for overlapping side effects, such as immune suppression or liver strain.
• Considering biologics that may improve both HS and psoriasis simultaneously.

A unified approach can reduce the number of medications needed and improve overall patient outcomes.

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Expert Opinions and Current Research

Dermatologists are increasingly aware of the HS–psoriasis connection, and recent studies are shining a light on how the two may influence each other.

New Research Findings

A 2023 narrative review uncovered a surprising twist — in some psoriasis patients, starting biologic therapy led to drug-induced HS. While rare, it shows the complexity of how treatments for one inflammatory disease can trigger another.

Another major focus is on shared inflammatory pathways, particularly IL-17, which appears to play a central role in both diseases. Understanding these overlaps could pave the way for dual-action treatments that target both conditions.

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Where Future Studies Are Headed

Scientists are exploring:

• Biomarkers to predict which psoriasis patients are at highest risk of HS.
• Treatment sequencing — whether tackling one disease first improves outcomes for the other.
• Genetic mapping to uncover specific immune-related mutations that predispose people to both.
• Quality of life research to measure how living with both conditions impacts mental health, relationships, and work life.

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When to Seek Medical Attention

Because HS and psoriasis can be mistaken for less serious skin problems early on, recognizing the warning signs is critical.

Early HS Red Flags

• Painful bumps in the groin, armpits, or other skin-fold areas that keep coming back.
• Abscesses that don’t heal with home remedies.
• Pus or blood drainage from skin lesions.
• Development of skin tunnels between bumps.

Early Psoriasis Red Flags

• Red, scaly patches that persist for weeks or months.
• Thick, ridged, or pitted fingernails.
• Persistent itching or burning sensations.
• Joint stiffness or swelling, especially in the morning (possible psoriatic arthritis).

If you have one of these conditions and notice symptoms of the other, seeing a dermatologist early can prevent years of undiagnosed discomfort.

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The Importance of Specialist Care

Both HS and psoriasis require specialized dermatological management. A general skin cream from the drugstore will not address the underlying immune dysfunction.

Specialist care can:

• Ensure accurate diagnosis and avoid mislabeling the disease as acne, eczema, or a fungal infection.
• Create personalized treatment plans that consider both conditions together.
• Monitor for side effects and complications.
• Provide access to clinical trials for new therapies.

For patients with both HS and psoriasis, it’s ideal to work with a dermatologist experienced in complex inflammatory skin diseases, as they’re more likely to be up to date on cutting-edge treatment strategies.

Living Well with Both Conditions

Managing hidradenitis suppurativa and psoriasis together isn’t just about taking medication — it’s about making lifestyle choices that help control symptoms, prevent flare-ups, and protect mental well-being.

Lifestyle Modifications That Make a Difference

1. Maintain a Healthy Weight
Excess body weight increases skin friction and inflammation, which can worsen both HS and psoriasis. Even a 5–10% weight loss can lead to noticeable symptom improvement. A diet rich in anti-inflammatory foods — such as leafy greens, fatty fish, berries, nuts, and whole grains — can support long-term skin health.

2. Quit Smoking
Smoking is one of the most powerful triggers for both diseases. Quitting can improve treatment response and reduce flare severity. Nicotine replacement, support groups, and apps like SmokeFree can help break the habit.

3. Manage Stress Proactively
Stress doesn’t cause HS or psoriasis, but it can spark flare-ups by ramping up immune system activity. Mindfulness meditation, yoga, journaling, or simply taking daily walks can help calm the nervous system.

4. Develop a Gentle Skin-Care Routine
Avoid harsh scrubs or fragranced products that can irritate sensitive skin. Opt for mild, pH-balanced cleansers, and keep skin folds dry to reduce bacterial growth. Loose-fitting cotton clothing can minimize friction and moisture buildup.

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Building a Strong Support Network

The emotional toll of chronic skin diseases is often underestimated. Pain, visible symptoms, and the unpredictability of flare-ups can lead to isolation, depression, and anxiety. Building a network of support is essential.

• Join patient advocacy groups like the HS Foundation or the National Psoriasis Foundation.
• Engage in online communities where you can share experiences and learn tips from others.
• Educate family and friends so they understand the conditions and can offer practical help.
• Seek mental health counseling if feelings of hopelessness, shame, or anxiety become overwhelming.

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Long-Term Management Strategies

When it comes to HS and psoriasis, there’s no “quick fix.” Successful management is about consistency, monitoring, and adaptation.

1. Regular Dermatology Appointments
Keep up with follow-up visits to track progress, adjust medications, and monitor for side effects.

2. Keep a Symptom Diary
Recording diet, stress levels, weather conditions, and flare-ups can help pinpoint personal triggers.

3. Stay Informed About New Treatments
Medical research is evolving quickly. Ask your doctor about emerging therapies, clinical trials, or switching biologics if your current plan isn’t effective.

4. Balance Expectations
Treatments can greatly improve symptoms but may not completely eliminate them. Focusing on overall quality of life rather than 100% skin clearance can lead to better mental well-being.

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Moving Forward with Confidence

Yes — having both HS and psoriasis presents unique challenges. But with the right combination of medical care, self-management, and support, people can live fulfilling, active lives.

Recent research and growing awareness mean doctors are better equipped than ever to identify and manage both conditions. Advances in biologics, personalized medicine, and lifestyle-based care are giving patients more options and more hope.

The key takeaways for anyone navigating these conditions:

• Early diagnosis leads to better outcomes.
• Coordinated care between specialists ensures safer, more effective treatment.
• Lifestyle changes can significantly reduce flare-ups.
• Mental health support is just as important as physical treatment.

By staying proactive, informed, and engaged in your care, you can take control of your health rather than letting your conditions control you.

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Conclusion

The link between hidradenitis suppurativa and psoriasis is more than just a medical curiosity — it’s a real and significant overlap that can impact diagnosis, treatment, and patient quality of life. While these two conditions may affect different parts of the body and show different symptoms, they share inflammatory pathways, genetic risk factors, and environmental triggers.

Living with both conditions is challenging, but not hopeless. With timely medical intervention, consistent treatment, and supportive lifestyle changes, people can minimize symptoms, maintain confidence, and lead rich, fulfilling lives.

Ongoing research promises even more targeted therapies in the future, making it increasingly possible to manage both HS and psoriasis effectively — and perhaps even prevent one from triggering the other in high-risk individuals.

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FAQs

1. Can treating psoriasis also improve hidradenitis suppurativa?
In some cases, yes. Certain biologics used for psoriasis target overlapping inflammatory pathways that may also reduce HS symptoms.

2. Are HS and psoriasis contagious?
No — neither condition is infectious. They are caused by immune system dysfunction, genetics, and environmental factors.

3. Can diet really make a difference for these conditions?
While diet alone won’t cure HS or psoriasis, anti-inflammatory eating patterns can help reduce flare frequency and improve overall health.

4. What’s the biggest mistake people make when managing these conditions?
Delaying medical treatment. Early diagnosis and intervention are critical to preventing long-term damage.

5. Should I see a dermatologist or a general practitioner first?
If you suspect HS, psoriasis, or both, it’s best to see a dermatologist, as they specialize in diagnosing and managing complex skin conditions.