The Connection Between Hidradenitis Suppurativa and PCOS

Research has shown that hidradenitis suppurativa (HS) and polycystic ovary syndrome (PCOS) are comorbidities (conditions that frequently occur together) in females. HS is a chronic inflammatory skin disorder. PCOS is a hormonal disorder in people with ovaries.

This article will discuss the two conditions, how they are linked, their symptoms, treatment, and more.

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a chronic inflammatory skin disorder that causes painful pus-filled nodules and abscesses to form around the hair follicles. HS lesions typically occur in the armpits, groin, abdominal folds, and breast areas. When these nodules erupt they can cause sinus tracts (tunneling under the skin) and scarring that can limit mobility.

HS is 3 times more likely to occur in women than men. While there is no cure for the disease, early treatment can slow progression and prevent severe scarring.  

What Is PCOS?

Polycystic ovary syndrome is a hormonal disorder that affects people with ovaries who are of reproductive age. Those with PCOS will have at least two of the following conditions:

• Irregular or absent menstrual periods
• Higher levels of androgens (a type of hormone) that may cause excess facial or body hair
• Cysts on one or both of the ovaries

PCOS is the most common cause of infertility that results from a lack of ovulation (release of an egg from the ovary).

Other symptoms include:

• Acne
• Weight gain
• Irregular bleeding
• Dark patches of skin
• Unwanted hair growth

PCOS also increases your risk for obesity, type 2 diabetes, obstructive sleep apnea (breathing stops and starts during sleep), heart disease, endometrial hyperplasia (abnormality of the lining of the uterus), and metabolic syndrome (a condition with high blood pressure, high blood sugar, abnormal lipid levels, and excess abdominal fat).

The Link Between HS and PCOS

Though evidence is limited on the exact link between HS and PCOS, inflammation, genetics, and hormones all appear to have a role in their connection. PCOS is the second most common comorbidity of HS.

Having PCOS may make you prone to developing HS. Researchers have shown that there is a clear dermatological (skin) component to PCOS linking a variety of skin conditions such as acne, seborrheic dermatitis (a chronic inflammatory skin condition), and hidradenitis suppurativa to the disease.

The opposite may hold true as well. PCOS is a complex disease that often takes time to diagnose.

It is possible to be diagnosed with HS first. If you have HS and develop excess androgen signs of PCOS such as increased facial hair or infertility, you may want to be screened for PCOS.

Symptoms

While the symptoms of PCOS and HS are different, they can occur at the same time and make it seem as though one affects the other. Symptoms of HS and PCOS that overlap can include:

• Weight gain
• Acne
• Other skin problems
• Depression

Symptoms of both diseases can be exacerbated (worsened) by stress, hormones, inflammation, and weight gain.

Excess Stress

Experiencing excess stress while living with PCOS can cause changes in body composition leading to an increased body mass index (BMI) and insulin resistance (the body does not use insulin well, resulting in high blood sugar levels). Stress is also a common factor in infertility.

Living with HS can cause emotional stress. Feelings of embarrassment or shame over the appearance of HS lesions and scarring are common.  

Together the stress of each disease can increase symptoms of both. Working to decrease your stress levels can help symptoms of both HS and PCOS.

Hormonal Changes

Hormonal changes are a hallmark of PCOS. Hormones play a role in the symptoms of the disease and affect menstruation, skin condition, hair growth in unwanted places, and fertility.

Hormones are believed to be involved in the development of HS. Hormones affect the hair follicles and increase the production of skin oils, which perpetuates the cycle of skin abscesses and lesions.

It is also known that people who menstruate tend to have worsening HS symptoms around the time of their period due to an increase in hormonal activity.

Hormones are directly linked to both diseases.

Inflammation

Inflammation is strongly tied to both HS and PCOS. Inflammation is one of the underlying mechanisms of PCOS that is believed to cause skin problems.

HS is known as an inflammatory disease of the sweat glands and hair follicles. Having HS and PCOS can exacerbate the inflammatory process and increase symptoms of both diseases.

Weight Gain

Weight gain can occur in both diseases. In fact, weight gain is a common symptom of PCOS. In HS, weight gain can occur in advanced disease due to open wounds and scar tissue that make exercise difficult.

It is also well established that obesity is a risk factor for both diseases. Maintaining a proper weight can help manage symptoms of both HS and PCOS and prevent the development of further comorbidities.

Treatments for HS and PCOS

Treatments that have shown promise in both HS and PCOS are focused on the hormonal imbalances that occur with each disease. These include birth control pills, Aldactone (spironolactone), and Propecia or Proscar (finasteride).

As with any medication, it is important to talk to your healthcare provider about the best treatment for you and your symptoms.

Birth Control Pills

Due to the observed effects of hormonal imbalances on both PCOS and HS, hormonal birth control pills containing ethinyl estradiol and norgestrel may help with symptoms. While further studies are needed, there is promise in the use of birth control to help lower the effects of high androgen hormones. 

Spironolactone

Aldactone (spironolactone) is a hormone therapy that has been used to treat HS and manage symptoms. In one study it was shown to decrease lesions, pain, and slow progression.

In another study, a low dose of the drug was found to help symptoms of PCOS and lower the levels of androgen hormones which are usually high in those living with the disease.

Finasteride

In the treatment of HS, one study found that Propecia or Proscar (finasteride) helped with advanced HS symptoms and can possibly resolve symptoms. It is an anti-androgenic drug (one that works against androgen hormones).

Those with PCOS who were treated with finasteride saw a reduction in facial hair growth (hirsutism). While the drug was effective at relieving these symptoms, finasteride, along with other drugs such as spironolactone, would benefit people with PCOS.

Summary

Hidradenitis suppurativa and polycystic ovary syndrome frequently occur together and have symptoms that may overlap. Treatments for the diseases focus on maintaining a healthy weight, reducing stress, and balancing hormones.

A Word From Verywell

Having one disease is often difficult enough, but having two can feel overwhelming. Talking to your healthcare provider about your concerns can offer you a sense of control. Seeking the help of a mental health professional or finding a support group can help you feel less alone when dealing with multiple diseases.