There appears to be a genetic component to hidradenitis suppurativa, but we don’t know enough yet to be sure. While it tends to run in families, environmental factors also seem to play a role.

Hidradenitis suppurativa (HS) is a skin condition that can resemble severe acne or boils. Also known as acne inversa, HS is known for causing painful lumps under your skin, which can break open and scar. Such abscesses mostly develop in the groin, underarm, inner thigh area, and under the breasts.

While dermatologists know how to identify and treat HS, we still don’t know the exact cause of this inflammatory skin condition. But some experts think that HS may run in families.

While the exact cause of HS isn’t clear, experts do think this skin condition runs in families. In fact, about 33% to 40% of people with HS have a first-degree relative, such as a parent or sibling, who also has HS.

But not everyone who has a close relative with HS will go on to develop it. So while HS may be hereditary, lifestyle and environmental factors might also play a role.

How common is HS?

HS has a prevalence of between 0.03% and 4% worldwide. In the United States, it affects about 0.1% to 0.4% of people, and those assigned female at birth are at a slightly higher risk.

But researchers believe that these numbers may be higher due to underreporting and misdiagnosis of HS.

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A combination of genetics and environmental triggers likely causes HS.

Researchers previously thought that HS developed due to a problem with the hair follicles. But they now think that the inflammation may be an autoimmune disorder. Some genetic factors support the idea that HS could be an autoinflammatory disease. It’s still not clear, but scientists are continuing to look at this possibility.

Smoking cigarettes may be the most common environmental trigger. About 70% to 90% of people with HS smoke cigarettes.

But like its genetic component, the triggers of HS are variable as well. For example, while many people with HS smoke cigarettes, not everyone who smokes will develop this skin condition.

The development of HS varies globally, which researchers believe may stem from variations in ethnicity across different regions.

In the United States, Black people are at a higher risk of developing HS and tend to have more severe cases. Hispanics and biracial people are also at a higher risk. Still, scientists don’t know why this is the case.

Other risk factors for HS include:

  • overweight and obesity
  • psoriasis
  • smoking
  • being under the age of 40
  • being assigned female at birth, which suggests that hormones may play a role

Research indicates that some people with HS have mutations involving the gamma-secretase Notch signaling pathway, which controls cellular development. However, at this time, there’s no genetic test for HS.

Instead, a dermatologist can diagnose a suspected case during a physical exam. A dermatologist is a doctor who specializes in treating diseases of the skin, hair, and nails.

Are you born with HS, or do you develop it?

People with HS tend to develop it after puberty and before 40 years of age. It’s rare to develop HS before puberty, and you aren’t born with this condition. In fact, HS mostly occurs between the ages of 21 and 29.

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While up to 40% of people with HS have first-degree relatives with this skin condition, there’s no definitive way to predict whether your child might develop HS.

You might consider talking with your child’s pediatrician about your personal or family history of HS so they may look out for possible symptoms. It’s also important to discuss this with your child as they get older, as the condition tends to develop after puberty and in early adulthood.

Until scientists can uncover the exact cause of HS, it’s unclear whether you can prevent HS. But you may be able to remove known lifestyle and environmental risk factors that can increase your chances of developing HS. This includes quitting smoking and managing your weight.

A dermatologist can also recommend a treatment plan to help prevent the severity and number of HS flare-ups. This may involve a combination of medications, in-office procedures, and skin care products.

There’s no cure for HS. But treatments can help you manage and prevent flare-ups.

Some people assigned female at birth may also experience fewer HS flare-ups and overall decreased severity during pregnancy and after menopause.

HS is an inflammatory skin condition that some groups may be more predisposed to. This includes people of certain ethnicities, those assigned female at birth, and those with a family history of HS.

While HS runs in some families, it’s not yet clear whether there’s a direct genetic link. Some people who develop HS may not have a family history of this skin condition at all.

If you suspect you may be experiencing symptoms of HS or another difficult-to-manage skin condition, see a dermatologist for an evaluation. You can’t cure HS, but there are options that can help you manage it.