Most people don't realize that if you have hidradenitis suppurativa (HS), you're about twotothree times more likely to also develop psoriasis and the reverse is true as well. The connection comes from shared inflammation pathways, common lifestyle triggers like smoking and obesity, and a bundle of overlapping health issues.
Why does this matter to you? Knowing about the hidradenitis psoriasis link lets you catch early signs of the other condition, have a more focused conversation with your dermatologist, and choose treatments that can calm both fires at once. Let's dive into the facts, the science, and the everyday tips that can make life with these skin conditions a lot less stressful.
How Common Is It
Prevalence of Each Condition
Hidradenitis suppurativa affects roughly 0.7%1.2% of the global population, according to a review in Frontiers in Immunology. Psoriasis is more common, showing up in about 2%3% of people worldwide (National Psoriasis Foundation).
Odds of CoOccurrence
A 2023 metaanalysis of over 15,000 patients found that those with HS were 2.6times more likely to also have psoriasis, and psoriasis patients showed a similar increased risk for HS. In plain English: if you've been diagnosed with one, the chance of the other isn't negligible.
Who's Most at Risk?
The overlap shows up most often in adults aged 2040. Women tend to dominate HS cases, while psoriasis affects both sexes fairly evenly. Lifestyle habits matter a lot smoking and a bodymass index over 30 dramatically raise the odds. Shared comorbidities such as metabolic syndrome, inflammatory bowel disease, and certain forms of arthritis also tip the scales.
RealWorld Snapshot
| Age | Sex | Primary Diagnosis | Secondary Diagnosis | Treatment That Helped |
|---|---|---|---|---|
| 35 | Male | Psoriasis (age28) | HS (age33) | Adalimumab after failure of separate therapies |
| 42 | Female | HS (age30) | Psoriasis (age38) | Combination of apremilast and lifestyle changes |
Why They Overlap
Shared Immune Pathways
Both conditions light up the same inflammatory messengers primarily IL17, IL23, and TNF. These cytokines drive the "th17" response, leading to the red, painful lesions you see on the skin. When one pathway is overactive, the other often follows suit.
Genetic & Environmental Triggers
Genetic studies have highlighted overlapping risk genes such as IL23R, CARD14, and the classic psoriasis locus PSORS1. Add in smoking and excess weight, which both amplify the IL17 axis, and you've got a perfect storm for a dual diagnosis.
Diagram Idea (for the full article)
Imagine a Venn diagram where one circle holds "HSspecific factors" and the other "Psoriasisspecific factors." The overlap would be the cytokines (IL17, IL23, TNF), shared genes, and lifestyle risks.
Expert Insight
Dr. Steven Devos, a boardcertified dermatologist, notes, "When you see a patient with stubborn HS lesions who also has scaly plaques, it's time to think about the hidradenitis psoriasis link and consider a therapy that addresses both."
Spotting the Signs
Typical HS Symptoms
HS usually starts with painful, peasized nodules in areas where skin rubs together the armpits, groin, and under the breasts. These nodules can burst, forming foulsmelling tunnels (sinus tracts) that scar over time.
Typical Psoriasis Symptoms
Psoriasis shows up as welldefined, silveryscale plaques, often on the elbows, knees, scalp, and lower back. There's also an "inverse" form that thrives in skin folds, looking smooth and red easy to mistake for HS.
RedFlag DualDiagnosis Clues
If you've begun a biologic for psoriasis and notice a sudden flare of HSlike boils, or if longstanding HS patients develop new, scaly patches on typical psoriasis sites, it's worth a second look. The paradoxical reactions can be tricky but are usually manageable.
Quick Checklist
| Symptom | HS | Psoriasis | When Both? |
|---|---|---|---|
| Location | Axilla, groin, buttocks | Scalp, elbows, knees | Intertriginous folds |
| Appearance | Tender nodules draining sinuses | Silveryscale plaques | Redness + scaling in folds |
| Triggers | Heat, friction, weight gain | Stress, infection, meds | Smoking, obesity |
Getting the Right Diagnosis
Clinical Examination
Your dermatologist will usually rely on a visual exam plus scoring systems Hurley staging for HS and the PASI (Psoriasis Area and Severity Index) for psoriasis. These tools help track severity and guide treatment choices.
Lab Tests & Imaging
Blood work isn't diagnostic on its own, but a CBC and CRP can confirm systemic inflammation. A skin biopsy is rarely needed unless the lesions look atypical; it can help separate inverse psoriasis from HS nodules.
When to Call in Specialists
If you suspect joint pain, a rheumatologist may be needed to rule out psoriatic arthritis or HSrelated arthropathy. Nutritionists or endocrinologists become allies when obesity and metabolic syndrome are part of the picture.
Ask Your Doctor
Bring a list of all medications (especially biologics) to your appointment. Mention any recent lifestyle changes, new skin areas, or flareups that seem out of the ordinary.
Treatments That Work
Lifestyle First
Quitting smoking and shedding just 5% of your body weight can lower IL17 levels and calm both diseases. It's not a magic bullet, but it's the foundation that makes medicines work better.
Topical & Systemic Options
| Drug Class | Effective for HS? | Effective for Psoriasis? | Key Notes |
|---|---|---|---|
| Antibiotics (clindamycin+rifampin) | Good for mildmoderate HS; no psoriasis benefit. | ||
| Retinoids (acitretin) | (moderate) | (especially pustular) | Teratogenic strict contraception needed. |
| TNF inhibitors (adalimumab, infliximab) | First biologic with FDA HS indication; monitor for paradoxical flares. | ||
| IL17 inhibitors (secukinumab, ixekizumab) | (possible paradoxical HS) | Watch for new HS lesions after start. | |
| IL23 inhibitors (guselkumab, risankizumab) | Emerging data (beneficial) | Promising dualaction; still limited HS studies. | |
| PDE4 inhibitor (apremilast) | (some response) | Oral, welltolerated; useful bridge therapy. |
Surgical Measures (HSOnly)
When tunnels become stubborn, incision and drainage can relieve pain, but they're temporary. Laser excision (CO) or wide excision surgery are more definitive for Hurley stageIII disease. Always discuss postop wound care it can affect psoriasisrelated healing.
Handling Paradoxical Reactions
If an IL17 blocker sparks new HS lesions, the usual fix is to switch to a different biologic class, often a TNF inhibitor. A 2023 case series showed most patients saw remission within three months after the switch.
Expert Guidance
According to a study in Macca etal., 2023, patients who transitioned from secukinumabinduced HS to adalimumab achieved significant improvement without worsening psoriasis.
Living With Both
Emotional Support
Dealing with two chronic skin conditions can feel overwhelming. Online communities like MyPsoriasisTeam and the HS Foundation offer peer support, practical tips, and a safe space to vent. Consider counseling if anxiety or depression creeps in you're not alone.
Daily Care Hacks
- Choose fragrancefree, gentle cleansers.
- Wear loose, breathable fabrics to reduce friction.
- Apply zincoxide barrier creams in skin folds to keep moisture out.
- Keep a simple symptom diary date, scores (HSPGA, PASI), meds, triggers and share it at each visit.
Tracking Flares
A spreadsheet can be a lifesaver. Columns for "Lesion location," "Pain level," "New medication," and "Lifestyle change" let you spot patterns you might otherwise miss.
Trusted Resources
The American Academy of Dermatology provides downloadable PDFs on both HS and psoriasis management; linking to them can give you a solid, physicianapproved reference you can keep on your phone.
Conclusion
The hidradenitispsoriasis link isn't just a quirky footnote it's a real, biologically grounded connection that impacts how you experience, diagnose, and treat both conditions. By recognizing the shared inflammatory pathways, watching for overlapping symptoms, and opting for therapies that address both fires, you can move from a cycle of frustration to one of control.
Lifestyle tweaks like quitting smoking and modest weight loss may feel like small steps, but they lay the groundwork for bigger improvements. Keep an open dialogue with your skin specialists, track your flares, and lean on supportive communities when the journey feels tough.
What's your story? Have you noticed both conditions showing up together, or do you have questions about a specific treatment? Share your experience in the comments below we'd love to hear from you and help each other navigate this dual diagnosis.
FAQs
What is the hidradenitis‑psoriasis link and how common is it?
The hidradenitis‑psoriasis link refers to the increased likelihood that a person with hidradenitis suppurativa (HS) will also develop psoriasis, and vice‑versa. Studies show people with one condition are about 2‑3 times more likely to have the other, especially in adults aged 20‑40.
Which symptoms suggest I might have both HS and psoriasis?
Look for painful nodules or draining tunnels in skin folds (HS) together with well‑defined, silvery‑scale plaques on elbows, knees, scalp, or smooth red patches in intertriginous areas (psoriasis). New scaly patches in typical psoriasis sites or sudden HS‑like boils while on a psoriasis biologic are red‑flag clues.
Are there treatments that work for both conditions?
Yes. Biologic agents that target shared cytokines—especially TNF‑α inhibitors (e.g., adalimumab) and, increasingly, IL‑23 inhibitors—have shown efficacy for both HS and psoriasis. Oral PDE‑4 inhibitor apremilast and lifestyle changes (quit smoking, modest weight loss) also help both diseases.
Can biologic medications cause a flare of the other condition?
Paradoxical reactions can occur. IL‑17 blockers, while excellent for psoriasis, have been reported to trigger new HS lesions in some patients. Switching to a different class, such as a TNF‑α inhibitor, usually resolves the flare within a few months.
How can lifestyle changes reduce the risk of having both diseases?
Smoking cessation and losing about 5 % of body weight lower IL‑17 activity and improve response to medication. Wearing loose, breathable clothing, using fragrance‑free skin care, and maintaining a symptom diary also help keep both conditions under control.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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