What Is the Connection Between Hidradenitis Suppurativa and Polycystic Ovary Syndrome (PCOS)?

HS and PCOS are two separate conditions, but it’s possible to have both.

HS is a chronic inflammatory skin condition that causes boil-like nodules to form under your skin. These often develop into skin sores and may cause significant scarring.

PCOS refers to a set of symptoms that can affect people assigned female at birth. These symptoms result from an imbalance in sex hormones, including unusually high levels of androgens.

Ovaries produce multiple types of sex hormones, including estrogen and androgens. Androgens are sometimes known as “male hormones” because men’s bodies tend to produce more androgens than women’s bodies do. Both men and women need certain levels of androgens for optimal health, but too much can cause health challenges.

Changes in how your body produces and responds to insulin may also contribute to symptoms of PCOS.

A 2018 study of 22,990 female patients with HS found that 9% of them also had PCOS, compared with less than 3% of the general population.

A 2019 review of case-controlled studies also found that people with HS had an increased risk of PCOS, although some studies found a higher risk than others.

More research is needed to learn why people with HS have an increased risk of PCOS.

Some people with HS show signs of elevated androgens, which may help account for the increased risk of PCOS. But studies have not consistently linked HS to elevated androgens. Being above a moderate weight raises the risk of both conditions.

Experts believe that HS develops when abnormal hair follicles become blocked and burst. Most cases of PCOS develop when the ovaries produce too many androgens.

More research is needed to learn why these things happen. Multiple factors likely play a role, including:

• genetic factors
• hormonal factors
• environmental factors

Researchers are continuing to identify and study genes that might affect the risk of HS and PCOS.

HS mainly affects your skin, and PCOS can affect multiple parts of your body.

Potential symptoms of HS include:

• hard lumps or nodules under your skin
• tunnel-like wounds under your skin, known as sinus tracts
• pimple- or boil-like sores on your skin
• abscesses that leak blood and pus
• open wounds that won’t heal
• scarring

Potential signs and symptoms of PCOS include:

• menstrual irregularities, such as:
  • no menstrual periods
  • skipped menstrual periods
  • unusually heavy menstrual periods
  • menstruation without ovulation
• abnormal growths on one or both of your ovaries
• excess hair growth on your face or body
• obesity, weight gain, or difficulty losing weight
• dark skin patches
• oily skin
• acne
• infertility

There’s no cure for HS or PCOS, but getting treatment may help limit symptoms and improve quality of life.

Your primary care doctor may prescribe treatment themselves or refer you to a specialist, such as a dermatologist to treat HS and a gynecologist or endocrinologist to treat PCOS.

Your recommended treatment will depend on your specific symptoms. Potential treatments for HS include:

• lifestyle changes, such as changes to your:
  • skin care routine
  • clothing choices
  • exercise habits
  • smoking habits
  • diet
• oral or injectable medication, such as:
  • antibiotics
  • corticosteroids
  • immunosuppressants
  • anti-androgenic hormone therapy
  • retinoids
  • tumor necrosis alpha (TNF-a) inhibitors
• light or laser therapy
• laser hair removal
• surgery
• topical treatments

Potential treatments for PCOS include:

• lifestyle changes, such as changes to your:
  • diet
  • exercise habits
  • smoking habits
  • skin care routine
  • hair removal practices
• oral, injectable, or topical medications, such as:
  • oral contraceptives
  • anti-androgen hormone therapy
  • insulin-sensitizing agents
  • metformin
  • acne medication

PCOS can make it harder to get pregnant. If you’re having trouble getting pregnant, your doctor may refer you to a fertility specialist for testing and treatment.

If HS or PCOS is affecting your mental health, your doctor may also refer you to a mental health professional who can help you cope with the emotional and social effects of these conditions. You might also find it helpful to join a support group for people with HS or PCOS.

People assigned female at birth with HS have an increased risk of PCOS, but more research is needed to understand why.

If you suspect you may have one or both conditions, let your doctor know. Depending on your specific symptoms, they may prescribe a combination of lifestyle changes, medication, and other treatments. Getting treatment may help limit symptoms, reduce your risk of complications, and improve your quality of life.

If HS or PCOS is affecting your mental health, your doctor may refer you to a mental health professional who can help you cope with the emotional and social challenges of living with these chronic conditions.