Some evidence suggests that a connection may exist between hidradenitis suppurative (HS) and polycystic ovary syndrome (PCOS). However, researchers are still unsure exactly what the connection is.

Hidradenitis suppurativa (HS), also known as acne inversus, is a chronic, inflammatory skin condition that causes deep lesions in the skin. Polycystic ovary syndrome (PCOS) is a condition that causes hormonal imbalance and metabolic issues.

This article explores what medical experts know about HS and PCOS, including the possible connection between the conditions and the possible causes, symptoms, and treatments for each condition.

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1445621758 Close-up of young man receiving cosmetic treatment for acne and pimples. Pyrosky/Getty Images

HS is a chronic, inflammatory skin condition. It can cause several skin-related symptoms, including:

  • deep nodules and abscesses
  • draining tracts
  • fibrotic scars

These symptoms can lead to pain, odor, and scarring.

PCOS is a hormonal imbalance that can cause various symptoms, such as:

  • acne on the face, back, and chest
  • extra hair growth on areas such as the face
  • weight gain
  • hair thinning

The two conditions share some features. Both conditions:

  • have no cure
  • may lead to other health complications
  • can cause mild to severe psychosocial stress
  • often begin after puberty and may improve after menopause

In addition, both conditions have an association with hyperandrogenism, or high levels of androgen hormones. People often refer to androgen hormones as male hormones.

High androgen levels in a person’s blood are one of four possible criteria doctors use to diagnose PCOS.

The exact connection between HS and PCOS is still not clear.

Because both conditions involve hyperandrogenism, researchers have focused some, though limited, attention on the hormones.

The authors of a 2020 meta-analysis noted that few studies have looked at the connection between HS and PCOS. They found five case-control studies that suggest a link between the two conditions.

They suggest that people who have an HS diagnosis and experience symptoms of hyperandrogenism should get tested for PCOS. These people may also benefit from anti-androgen therapy.

Symptoms of hyperandrogenism can include acne and excessive hair growth in areas where males typically grow hair, such as on the chin and upper lip. Clinical features may be enough for a doctor to diagnose the condition.

A study from 2018 found that the prevalence of PCOS in people living with HS was 9% in a study group of more than 22,000 people undergoing care for HS. Additionally, people living with HS were 2.19 times more likely to have PCOS than those who did not have HS.

The researchers noted that the association between HS and PCOS is about as strong as the connection between HS and obesity or HS and diabetes.

However, they could not establish from their data the following points:

  • whether the severity of HS influenced the association with PCOS
  • the directionality of the connection — whether PCOS increased the risk of HS, HS increased the risk of PCOS, or both
  • the causal link
  • whether certain features of HS influenced the connection with PCOS

They concluded that an association exists and that a person with HS who has any indications of hyperandrogenism should undergo screening for PCOS. This means a person with HS may want to speak with a healthcare professional about PCOS screening.

Experts still do not know the exact cause of either HS or PCOS.

According to the American Academy of Dermatology Association (AAD), HS begins in the hair follicles, likely through the following process:

  1. A protein called keratin clogs a hair follicle.
  2. Sweat and more keratin build up in the hair follicle, allowing bacteria to grow.
  3. The buildup of keratin, bacteria, and sweat causes the follicle to burst, which leads to a deep, painful nodule.
  4. The leaking pus from one burst follicle gets trapped in additional follicles, leading to more nodules.
  5. As the skin heals, it creates scar tissue.

The AAD also suggests that HS may be an autoimmune condition due to the presence of certain antibodies. However, research has not yet verified this.

Several factors can increase a person’s risk of HS, such as:

  • Sex: Females have a higher risk, possibly due to hormones.
  • Age: HS typically begins between the onset of puberty and age 40.
  • Exposure to triggers: Possible triggers for HS include smoking and obesity.
  • Genetics: Having a family member with HS can increase a person’s risk of developing the condition.
  • Psoriasis: A person who has the skin condition psoriasis may have an increased risk of developing HS.

According to the Office of Women’s Health, possible causes of PCOS include:

  • high androgen levels
  • family history of the condition
  • high insulin levels in the blood

HS typically causes nodules to form in areas with coarse hair or skin-to-skin contact. Common sites include the armpits and the groin.

The nodules may:

  • be painful or uncomfortable to the touch
  • heal slowly or not fully heal before coming back
  • fill with pus
  • grow larger and join together

Without treatment, the condition can spread to additional hair follicles and lead to scarring.

PCOS can cause various symptoms, including:

  • excess hair growth in areas such as the face, the chin, and parts of the body where males typically have hair growth
  • acne
  • irregular menstrual cycles
  • darkening of skin around creases and folds of skin
  • hair thinning
  • skin tags
  • weight gain or difficulty losing weight

Learn more about PCOS symptoms.

There is no cure for HS or PCOS. However, treatments can help reduce symptom severity, slow or prevent progression, and prevent complications.

A person will usually work with a dermatologist to create a treatment plan for HS. Features of a treatment plan typically include:

  • Skin care: A person may benefit from using soaps with benzoyl peroxide or less harsh antiperspirants.
  • Medications: Topical and oral medications can help treat infections and reduce inflammation.
  • Procedures: A person may undergo incision and drainage, laser therapy, hair removal, or injections.
  • Wound care: Proper wound care can help decrease odor and relieve pain or discomfort.
  • Pain management: Options may include topical creams and oral medications.
  • Mental health care: A dermatologist may recommend therapies to address anxiety or depression.

Learn more about home treatment for HS.

PCOS care often involves a combination of medications and home care. Treatment can vary from person to person and will differ for people who want to become pregnant.

Common treatment approaches and recommendations include:

  • weight loss or management
  • hair removal
  • treatments to slow hair growth
  • hormonal birth control
  • anti-androgen medications
  • metformin to regulate insulin and androgen levels

Learn about natural treatments for PCOS.

The following sections provide answers to some frequently asked questions about HS and PCOS.

Does PCOS cause hidradenitis suppurativa?

The exact connection between HS and PCOS is not clear. HS increases a person’s chances of developing PCOS, and experts generally recommend that people with HS undergo screening for PCOS.

Can hormonal imbalance cause hidradenitis suppurativa?

Some evidence suggests that hormone levels and imbalances may cause HS or increase a person’s risk of developing it.

What autoimmune disease is connected with PCOS?

According to a 2018 study, the autoimmune disorder that has the most significant association with PCOS is autoimmune thyroid disease, though other conditions may also have a link to PCOS.

HS and PCOS have a connection, though medical experts do not yet fully understand the exact nature of the connection. Some evidence suggests that having HS increases the risk of PCOS. Additionally, some research notes that the connection may be due to similar hormonal imbalances in the two conditions.

Both conditions can cause changes in a person’s appearance, which may lead to psychosocial stress. There is not yet a cure for either condition. However, treatments can help prevent complications and reduce symptom severity.