Causes and Risk Factors of Hidradenitis Suppurativa

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Though the exact cause of hidradentis suppurativa isn't clear, it's thought to be the result of a blockage of the pilosebaceous unit (the hair follicle) in areas of skin containing apocrine sweat glands. Other factors that play a role include a family history of the condition, smoking, and obesity. There are several conditions that are associated with hidradenitis suppurativa development, including inflammatory bowel disease, metabolic syndrome, spondyloarthritis, and acne conglobata.

A woman smoking; smoking is a risk factor of hidradenitis suppurativa

Nicolas Balcazar / EyeEm / Getty Images

Common Causes

While hidradenitis suppurativa is not uncommon (with an estimated 1% to 4% of the population affected) there isn't a whole lot known about the precise cause of this skin condition.

Most experts believe that hidradenitis suppurativa is caused, at least in part, by blockage of the hair follicle by keratin. Keratin is the key protein that makes up skin, hair, and nails. It's hypothesized that keratin may create a plug within the pilosebaceous unit, or what is commonly called the pore or hair follicle.

This plug of keratin leads to irritation of the follicle. The follicle then becomes inflamed and leads to the development of a painful lump called a nodule. These nodules can then progress to abscesses, which damage the underlying skin tissue leading to sinus tracts and scarring.

Another thought is that the blockage is of the apocrine gland. Apocrine glands are special sweat glands that are found in the armpits, groin, genital area, and breast area.

Regardless, friction in areas prone to hidradenitis suppurativa seems to play a role as well.

It is widely held that there are several factors coming together to trigger hidradenitis suppurativa development. When these factors are present in those who are already genetically susceptible, the condition appears.

Hidradenitis suppurativa most often appears just after puberty or during the 20s. It rarely develops before puberty or after age 40. This condition is more common in women than in men by a margin of three or four to one.

It's important to understand that hidradenitis suppurativa is not caused by a lack of hygiene. It also is not contagious, so there are no worries about others in your household catching it.

Conditions Linked to Hidradenitis Suppurativa

There are several conditions that are associated with hidradenitis suppurativa:

  • Inflammatory bowel disease: Having inflammatory bowel disease makes it more likely you'll develop hidradenitis suppurativa. One study found that 17% of people with Crohn's disease and 14% of people with ulcerative colitis also had hidradenitis suppurativa.
  • Metabolic syndrome: Some studies have shown a sharp increase in metabolic syndrome in those with hidradenitis suppurativa.
  • Spondyloarthritis: The prevalence of hidradenitis suppurativa is higher in those who have spondyloarthritis than it is in those without this rheumatic disease.
  • Acne conglobata: Hidradenitis suppurativa is more common in those with this rare form of inflammatory acne. Interestingly, though, hidradenitis suppurativa is more common in people who have had any form of acne, even mild acne vulgaris.


There seems to be a strong genetic component. Up to 40% of people with hidradenitis suppurativa have a family member who also has the condition.

Some research suggests a mutation in the y-secretase gene may be responsible. But a single dominant gene responsible for the condition has yet to be discovered.

Lifestyle Risk Factors

There are several risk factors that make you more susceptible for developing hidradenitis suppurativa. This is especially true if you are genetically predisposed, or have a family history, of the condition.

Smoking: Cigarette smokers are more likely to develop hidradenitis suppurativa than non-smokers. In fact, smoking is considered a major triggering factor in development of the condition. Exactly how or why smoking cigarettes triggers hidradenitis development remains unclear.

Obesity: The prevailing thought is that the excess friction between the skin in the body folds of those who are overweight is what contributes to the development or worsening. Those who are obese are more likely to develop hidradenitis suppurativa. They are also more likely to have more severe, and longer-lasting, cases of the disease.

Stress: Stress doesn't cause the disease, but it can make existing cases worse. Many people notice stress exacerbates or brings on an episode.

Heat and sweat: Like friction, heat and sweat can lead to irritation of the follicles and bring about or worsen a breakout.

Menstrual cycle: Some women notice that their condition worsens just around the time of their monthly period.

A Word From Verywell

While the causes of hidradenitis suppurativa can be unclear, there are some risk factors you can reduce. If you are overweight or obese, losing weight may help. If you smoke, quitting can reduce your risks of this condition and many others. Avoiding developing abscesses will improve your quality of life.

Frequently Asked Questions

  • Is hidradenitis suppurativa a sexually transmitted infection?

    It is not. Although lesions often occur on the groin, anus, or breasts, you cannot get hidradenitis suppurativa through intimate contact with someone who has the condition.

  • Is there any way to prevent hidradenitis suppurativa?

    No. There are no vaccines, medications, or strategies known to stop hidradenitis suppurativa from developing in someone who's predisposed to it. Once it appears, however, there are ways to manage it that may help prevent flare-ups or at least make them less severe.

  • Is it OK to pop or squeeze hidradenitis suppurativa lesions?

    It's not a good idea. Often, the lesions will open up and drain spontaneously, but each time this happens scar tissue forms. It's best not to encourage this to occur unnecessarily. Opening the lesions also increases the risk of infection.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  6. Rondags A, Arends S, Wink FR, Horváth B, Spoorenberg A. High prevalence of hidradenitis suppurativa symptoms in axial spondyloarthritis patients: A possible new extra-articular manifestation. Semin Arthritis Rheum. 2019 Feb;48(4):611-617. doi:10.1016/j.semarthrit.2018.03.010

  7. Pink AE, Simpson MA, Desai N, Trembath RC, Barker JNW. γ-Secretase mutations in hidradenitis suppurativa: new insights into disease pathogenesis. J Invest Dermatol. 2013 Mar;133(3):601-607. doi:10.1038/jid.2012.372

  8. Sartorius K, Emtestam L, Jemec GB, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol. 2009 Oct; 161(4):831-9. doi:10.1111/j.1365-2133.2009.09198.x

  9. National Organization for Rare Disorders. Hidradenitis suppurativa.

  10. Cleveland Clinic. Hydradenitis suppurativa.

Additional Reading

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.