Hidradenitis suppurativa (HS) happens when the pores in your skin that surround hair roots, called hair follicles, get blocked. Experts don’t fully understand why this happens, but they do know who it’s most likely to happen to.
People in these groups are most at risk.
People With Certain Genes
Researchers have discovered at least three gene variants, NCSTN, PSEN1, and PSENEN, that are connected to HS. If you carry one of these variants, you may be more likely to get this skin condition. But these genes alone don’t explain every case of HS. People can have the disease without carrying those specific genes.
Other factors suggest that there could be other genes involved in this painful condition.
Black People
The role that race plays in HS could also have to do with genes. Black people are two to three times more likely to get HS than White people. About one in 75 Black people, or 1.3%, have HS. One in 130 White people, or 0.75%, have it. It’s very rare in people of other races or ethnicities.
Of course, genes aren’t the only things that people of the same race could have in common. In some – but not all – cases, they may share similar lifestyles or come from similar geographic locations. Both could affect the risk of certain diseases.
Family History
Not everyone who gets HS has relatives with the disorder, but many do. Up to 2 in 5 people with HS, and possibly more, also have a next-of-kin that has it. It’s possible to get the condition even when only one parent has it. This is often the case for people with one of the three gene variants known to raise the risk of HS, as well as for people who don’t have one of the known genes.
Families also have more in common than just genes. They may share similar lifestyles. They could also have other risk factors for HS in common, such as obesity.
People Who Are Overweight or Obese
HS is more common in people who are overweight or have metabolic syndrome. That’s when you have three or more conditions that make you more likely to get heart disease and diabetes, or to have a stroke. They include a large waistline, high blood pressure, high blood sugar, high LDL (“bad”) cholesterol, and low HDL (“good”) cholesterol. The disease is also more severe in overweight people.
Metabolic syndrome is a risk factor for both HS and diabetes. There seems to be a connection between these conditions. More than 1 in 10 people with HS have diabetes. That’s more than three times as high as the diabetes rate in people who don’t have HS.
It’s possible that hormone changes or problems play a part in both diseases.
People With Other Inflammatory Conditions
Ongoing inflammation in the body could also make it more likely. People who have other inflammatory diseases, such as arthritis and inflammatory bowel disease (IBD), are more likely to get HS than people who don’t have these conditions.
Some studies find that people with IBD are nine times more likely to get HS than others. It seems to be far more common in people with Crohn’s disease than those who have ulcerative colitis. It’s also more likely in those with active disease that a doctor can see using a tool called an endoscope – a thin tube with a camera on the end that he inserts into your anus and uses to take pictures of your colon.
Teenagers and Young Adults
HS most often develops in people between puberty and age 40. Within that group, the people most affected are young adults between the ages of 21 and 29. It seems to arise often in those who are still growing. This helps support the belief that hormones have something to do with its development.
Women
Maybe further underscoring a link to hormones, women are three times more likely to get HS than men. In women, the condition tends to crop up between puberty and menopause. Episodes and symptom severity often align with menstrual cycles or use of hormones, such as hormonal birth control or hormone replacement therapy.
People Who Smoke
Smoking is the lifestyle factor believed to have the biggest impact on HS risk. More smokers have HS than nonsmokers. Smokers with HS also have more severe disease than nonsmokers.
While it’s fairly simple for researchers to see the link between smoking and HS, it’s been harder for them to prove that smoking actually causes the condition. Studies that explore how smoking might lead to HS suggest that nicotine and chemicals in tobacco smoke lead to the kind of inflammation that triggers HS skin sores.
Show Sources
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SOURCES:
Mayo Clinic: “Hidradenitis Suppurativa.”
National Library of Medicine’s MedlinePlus: “Hidradenitis Suppurativa.”
JAAD International: “Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: A retrospective analysis of 2 U.S. cohorts.”
Journal of Cutaneous Medicine and Surgery: “Race-Specific Prevalence of Hidradenitis Suppurativa.”
National Institutes of Health: “What Is Metabolic Syndrome?”
My HS Team: “HS and Diabetes: Understanding the Connection.”
Canadian Society of Intestinal Research: “Hidradenitis Suppurativa and its Connection to IBD.”
National Library of Medicine’s StatPearls: “Hidradenitis Suppurativa.”
Cedars Sinai: “Hidradenitis Suppurativa.”
Acta Dermatovenerologica Croatica: “Understanding the Relationship Between Smoking and Hidradenitis Suppurativa.”
