Short answer · Medically reviewed summary · Last updated: 2026-04-07
TL;DR: Hidradenitis suppurativa is a complex, chronic inflammatory skin condition caused by the blockage and subsequent rupture of hair follicles, leading to a systemic immune response. While the exact etiology is still being researched, it is understood to be a multifactorial disease involving a combination of genetic predisposition, hormonal influences, and environmental triggers rather than a simple infection. What are the primary causes of Hidradenitis Suppurativa? Current medical research indicates that hidradenitis suppurativa is not caused by poor hygiene or a primary bacterial infection.
4 people with Hidradenitis Suppurativa have shared their first-person experience on this question at DiseaseMaps.
Which are the causes of Hidradenitis Suppurativa?
Causes of Hidradenitis Suppurativa explained: genetic and environmental factors, reviewed against medical sources, plus patient perspectives.
TL;DR: Hidradenitis suppurativa is a complex, chronic inflammatory skin condition caused by the blockage and subsequent rupture of hair follicles, leading to a systemic immune response. While the exact etiology is still being researched, it is understood to be a multifactorial disease involving a combination of genetic predisposition, hormonal influences, and environmental triggers rather than a simple infection.
What are the primary causes of Hidradenitis Suppurativa?
Current medical research indicates that hidradenitis suppurativa is not caused by poor hygiene or a primary bacterial infection. Instead, the process begins deep within the hair follicle. Think of the hair follicle as a tiny tunnel; in patients with hidradenitis suppurativa, this tunnel becomes clogged with keratin (a skin protein). As the follicle expands due to this blockage, it eventually ruptures, spilling its contents into the surrounding skin tissue. This triggers a powerful, persistent inflammatory response from the body’s immune system, resulting in the painful nodules, abscesses, and sinus tracts characteristic of the disease.
Is Hidradenitis Suppurativa hereditary?
Genetic factors play a significant role in the development of hidradenitis suppurativa. Approximately 30% to 40% of patients report a family history of the condition. While it is not always inherited in a simple pattern, researchers have identified mutations in the gamma-secretase complex (genes NCSTN, PSENEN, and PSEN1) in some families. These genes are crucial for cell signaling and skin development. However, many individuals with hidradenitis suppurativa do not have these specific mutations, suggesting that the disease is polygenic, meaning multiple genes likely interact with environmental factors to trigger the condition.
What are the environmental and metabolic risk factors?
While the internal mechanism is biological, several lifestyle and metabolic factors are known to exacerbate the severity of hidradenitis suppurativa. It is vital to distinguish between a "cause" (the underlying biological dysfunction) and a "risk factor" (a trigger that makes the condition worse). Key triggers and associations include:
- Smoking: There is a strong, well-documented correlation between tobacco use and the severity of hidradenitis suppurativa.
- Obesity: High body mass index (BMI) can increase skin-on-skin friction and metabolic inflammation, which often worsens symptoms.
- Hormonal Fluctuations: Because the disease often begins after puberty and affects apocrine-gland-rich areas, androgens (sex hormones) are suspected to play a role in driving the inflammatory cycle.
- Mechanical Stress: Tight clothing or repetitive friction in the groin and axillae (armpits) can aggravate existing lesions.
How is current research evolving to understand the etiology?
The medical community is moving away from viewing hidradenitis suppurativa as merely a skin disease and is now characterizing it as a systemic inflammatory disorder. Ongoing research is heavily focused on the microbiome—the community of bacteria living on the skin—and how it interacts with the immune system to sustain chronic inflammation. Clinical trials are investigating targeted biologic therapies that block specific cytokines, such as TNF-alpha and IL-17, to dampen the immune system's overreaction. Understanding these pathways is essential for shifting treatment from invasive surgery toward personalized, systemic management.
Next steps
- Consult a board-certified dermatologist who specializes in inflammatory skin conditions.
- Track your symptom flares in a journal to identify potential personal triggers, such as specific foods or stress levels.
- Join the 729 members on DiseaseMaps.org to share experiences and learn about community-reported management strategies.
- Ask your physician about clinical trials currently exploring new biologic inhibitors for hidradenitis suppurativa.
Medical disclaimer: This content is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment; always seek the advice of your physician regarding a medical condition.
References
- NIH Genetic and Rare Diseases Information Center (GARD)
- Orphanet: Portal for rare diseases and orphan drugs
- OMIM (Online Mendelian Inheritance in Man): Entry #142690
- The Hidradenitis Suppurativa Foundation (HS-Foundation.org)
Posted Aug 21, 2017 by Penny 2150
There are two forms of HS, familial and sporadic. The HS family is one in which
the affected individual has blood relatives who are also affected, although the degree of
involvement can be very different. Assumes at least 40% of the cases, while our research
in the Spanish population indicate that we might get to correspond to 85% of the cases. The HS family is
a hereditary disease and is directly caused by genetic factors, i.e. mutations
specific genes in our genome, which can be identified through analysis genéticomoleculares.
For its part, the HS sporadic is one in which the affected individual do not have blood relatives with
HS. This can be explained both because his HS does not have genetic origins as by the fact that yes
the have and have not seen other family members affected - either because the mutation original founder of
the disease has occurred in that particular patient (who may have descendants affected), well
because the chance of the inheritance has done that you do not have affected relatives known.
In any case, it should be clear that as a general rule, not all the descendants of a patient
HS will inherit the disease.
Posted Aug 12, 2017 by NAT 1910
Posted Aug 12, 2017 by Ana 1000
Posted Oct 1, 2017 by Sonia 1000
