Living with a chronic skin condition can be tough, but having two can make things even harder. This is true for people diagnosed with both hidradenitis suppurativa (HS) and psoriasis.

One myHSteam member said, “I have been dealing with HS since I was 18, and now I’m 41. I also have psoriasis, so my skin is all kinds of a mess.”

HS usually affects areas where skin rubs together, like the groin, armpits, under the breasts, and the buttocks. Psoriasis often affects the skin around the elbows, knees, scalp, and trunk.

Both are inflammatory skin conditions with some similar symptoms and risk factors, but they also have differences as well. Here’s what you need to know about how they’re connected.

HS and Psoriasis Prevalence and Risk Factors

Hidradenitis suppurativa affects about 1 percent and 2 percent of the U.S. population. It usually starts after puberty.

Psoriasis is slightly more common, affecting 2 percent to 3 percent of the world’s population. It often begins between the ages of 20 and 30 or 50 and 60.

A review of several studies found that people with hidradenitis suppurativa are more than 2.6 times more likely to also have psoriasis than those without HS. Researchers didn’t find that one condition causes the other. Instead, they concluded that the two conditions often occur together. In most cases, psoriasis develops before HS.

Common Risk Factors

HS and psoriasis share several risk factors, including smoking and obesity. Both conditions are also linked to specific inflammatory proteins in the body called cytokines.

Related Health Conditions

Both HS and psoriasis are linked to several of the same co-occurring conditions, also called comorbidities. These include:

• Metabolic syndrome
• Diabetes
• Inflammatory bowel disease (IBD)
• Spondyloarthritis

Symptoms of Psoriasis and HS

Both psoriasis and hidradenitis suppurativa are inflammatory conditions that can affect your quality of life. While they share some similarities, they also have differences.

Hidradenitis Suppurativa

The first signs of HS are usually bumps that look like pimples or boils. Over time, these bumps can grow larger and band together. They can then form into painful abscesses that may break open. The repetitive reopening and healing of these sores can permanently scar the skin. This can lead to sinus tracts — tunnels that form under the skin.

HS flare-ups can cause severe pain and may even make it hard to move around comfortably.

Psoriasis

Psoriasis symptoms often include:

• Patchy, scaly skin plaques
• Itching, soreness, and burning
• Rashes that come and go

Psoriatic rashes can sometimes be confused with HS symptoms, especially when they appear in areas like the armpits or groin.

Two types of psoriasis have symptoms that look a lot like HS. These are called inverse psoriasis (also known as flexural psoriasis) and pustular psoriasis.

Inverse psoriasis usually appears in skin folds, like the armpits and around the genitals. Pustular psoriasis causes pus-filled bumps on the skin. Pustular psoriasis can be generalized, meaning it affects large areas, or localized, often affecting only the hands and feet.

When pustular psoriasis affects the palms and soles, it may also be called palmoplantar pustular psoriasis (PPP). Several myHSteam members have shared their experiences with this type of psoriasis.

“My HS is much better now, but I have developed PPP, which is psoriasis on the palms of my hands and the soles of my feet,” one member said. Another replied, “I think I have this too. Rash all over my palms.”

Inflammation in Psoriasis and HS

In both hidradenitis suppurativa and psoriasis, inflammation is responsible for symptoms. Researchers are studying whether the inflammatory pathways are the same in both conditions. Specific inflammatory markers, like interleukin (IL)-17 and IL-23, are higher in people with both conditions. Biologic therapies that target these markers are used to treat both HS and psoriasis.

Does One Condition Cause the Other?

Only a few case studies suggest that hidradenitis suppurativa causes psoriasis or that psoriasis causes HS. More research is needed. For now, scientists believe the two conditions are correlated (linked) but not caused by each other.

Because both conditions share common comorbidities, it’s hard to determine if one causes the other. In one large study, researchers found that most people with both conditions were young, smoked, and were obese compared to those with only psoriasis. This may point to a shared inflammatory pathway.

Treatment Options

Dermatologists treat both psoriasis and hidradenitis suppurativa. People with certain types of psoriasis may also see a rheumatologist. This is a doctor who specializes in inflammatory diseases. Rheumatologists are especially important for people with psoriasis who develop psoriatic arthritis (PsA), which affects the joints.

Hidradenitis Suppurativa Treatments

Common HS treatments include medication and wound care. A dermatologist may recommend:

• Biologics
• Antibiotics
• Steroid injections
• Hormonal therapy
• Retinoids
• Pain medications

Medical procedures such as laser therapy are sometimes used to treat hidradenitis suppurativa. Many of these procedures can be done in your dermatologist’s office.

Psoriasis Treatments

Dermatologists may recommend some of the same treatments for psoriasis as for HS, such as retinoids, steroids, and biologics. Other therapies treatments specific to psoriasis include:

• Vitamin D analogs
• Calcineurin inhibitors
• Light therapy
• Methotrexate
• Cyclosporine

Hidradenitis Suppurativa and Psoriasis Facts

There are several common misconceptions about HS and psoriasis. Here are the facts:

• HS and psoriasis are not contagious. They can’t be spread through sexual contact or touching.
• HS and psoriasis are not caused by poor hygiene.
• Higher body weight doesn’t cause HS or psoriasis. While extra weight can be a risk factor for both HS and psoriasis, people of all body sizes can develop these conditions.

People with hidradenitis suppurativa or psoriasis shouldn’t feel embarrassed. These conditions are not your fault.

If you’re unsure whether your skin condition is HS or psoriasis, talk to a dermatologist. You should also contact your doctor if you have HS and think you might be developing psoriasis. They can help diagnose your condition and create a treatment plan.

Find Your Team

If you or a loved one is living with HS, consider joining myHSteam today. Here, more than 46,000 members from around the world come together to ask questions, offer support and advice, and connect with others who understand life with hidradenitis suppurativa.

Are you worried about your risk of psoriasis while living with HS? Have you noticed lesions or nodules that don’t look like hidradenitis suppurativa? Share your experience in the comments below or by posting on your Activities page.