14 Common Causes of Hidradenitis Suppurativa

2. Acne

Acne and hidradenitis suppurativa can look alike, but they are not the same condition. Both cause painful bumps under the skin. Because of this, you or even a doctor may confuse early HS with severe acne. The similar appearance can delay the correct diagnosis.

Acne forms when hair follicles clog with oil, dead skin cells, and bacteria. This blockage leads to pimples, cysts, or nodules. HS also involves blocked follicles, but it often affects areas where skin rubs together, such as your armpits, groin, or under the breasts. Both conditions involve inflammation inside the skin and can lead to scarring over time.

You may notice blackheads in both acne and early HS. HS lumps often return in the same spots and may break open, leak fluid, and form tunnels under the skin. Acne usually appears on your face, chest, or back. When acne does not respond to common treatments and keeps returning in the same areas, a medical evaluation becomes important.

3. Diabetes

Diabetes affects how your body controls blood sugar. When blood sugar stays high for a long time, it can damage blood vessels and nerves. This damage can also affect your skin. Poor blood sugar control can raise inflammation levels, which may make hidradenitis suppurativa flare-ups more frequent or more severe.

Diabetes can weaken your immune system. When this happens, your body may struggle to fight bacteria trapped in blocked hair follicles. These blockages play a key role in hidradenitis suppurativa. Some risk factors overlap, including overweight and smoking. If you have type 2 diabetes or prediabetes, your risk of skin problems may increase.

Common skin changes linked to diabetes include thick or darkened patches of skin, frequent infections, slow wound healing, and dry, itchy skin. Proper blood sugar control through lifestyle changes and medicines such as insulin or other glucose-lowering drugs may help reduce stress on your skin and support better healing over time.

4. Heart Disease

Heart disease affects your heart and blood vessels. It can lead to chest pain, heart attack, or stroke. Many people with hidradenitis suppurativa face a higher risk of heart problems. Chronic inflammation plays a key role, since ongoing swelling in your skin can also affect your blood vessels over time.

Several shared risk factors link HS and heart disease, including smoking, obesity, high blood pressure, high blood sugar, and high cholesterol. If you smoke or carry extra weight, your HS symptoms may worsen. These same factors can also raise your risk of blocked arteries and added strain on your heart.

Some people with HS develop metabolic syndrome. This condition includes high blood pressure, high blood sugar, excess belly fat, and abnormal cholesterol levels. Together, these problems increase the risk of heart attack and stroke. Blood pressure checks and lab tests to review cholesterol and blood sugar levels can help identify heart risks early.

5. Digestive Disorders

Digestive disorders can play a role in hidradenitis suppurativa. If you live with inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, your risk may be higher. These conditions cause long-term swelling in your digestive tract. The same type of inflammation can also affect your skin.

When your immune system stays active for long periods, it can trigger problems in different parts of your body. In some people, HS develops around the groin or near the anus, which are also areas affected by bowel disease. This pattern suggests that ongoing gut inflammation may influence changes in the skin.

Digestive symptoms may appear before or after HS. These symptoms include ongoing stomach pain, diarrhea that does not improve, blood in the stool, and unplanned weight loss. Digestive disorders do not directly block hair follicles. They may raise overall inflammation levels, which can make HS flare-ups more frequent or severe.

6. Obesity

Obesity is a common risk factor for hidradenitis suppurativa. If you carry extra body weight, your risk of developing this condition may increase. Excess weight can also make symptoms more severe. Many people with HS notice more frequent flare-ups when body weight is higher.

When you have obesity, skin folds may rub together more often. This friction can irritate hair follicles, which are small openings where hair grows. Blocked and irritated follicles can trigger painful lumps under your skin. Areas such as the armpits, groin, or under the breasts may feel more irritated because sweat and moisture build up there.

Obesity also affects how your body handles inflammation. Fat tissue releases chemicals that raise inflammation levels. Since HS is linked to inflammation, this added stress may worsen flare-ups. Obesity often connects with smoking or hormone changes, and several risk factors at once can make symptoms harder to control.

7. Hormone Imbalance

Hormone changes can play a clear role in hidradenitis suppurativa. You may notice that symptoms begin after puberty. This pattern suggests that sex hormones influence how your skin behaves. Many people first develop HS during the teen years, when hormone levels rise and the body changes quickly.

Your body makes hormones such as estrogen and androgens, which control many functions. These hormones also affect hair follicles and oil glands. When levels shift, oil production and skin cell buildup can increase. This process raises the risk of blocked hair follicles, which is an early step in HS.

Flare-ups may appear around your menstrual cycle, especially before your period when hormone levels change. Pregnancy and menopause can also affect symptom patterns, and some medical treatments adjust hormone activity. These treatments aim to lower inflammation and reduce the number of new flare-ups over time.

8. Skin Disorders

If you have other skin disorders, they can raise your risk of hidradenitis suppurativa. Some conditions change how your skin cells grow, shed, or respond to bacteria. These changes can make it easier for hair follicles to clog and become inflamed, which can lead to painful lumps.

Acne is one example. It begins in the hair follicles and causes blocked pores and deep bumps. Ongoing acne can mean excess oil and bacteria on your skin. Psoriasis can also play a role. It causes fast skin cell buildup and thick, scaly patches, which may increase clogged follicles in areas where skin rubs together.

Conditions that affect sweat glands may also connect to HS. HS often forms in areas with many sweat glands, such as your armpits, groin, and under the breasts. Related skin issues include acne, psoriasis, folliculitis, and recurrent skin abscesses. These conditions share inflammation as a common feature.

9. Hormone Treatments

Hormone changes can affect how your skin behaves. Hidradenitis suppurativa often starts around puberty, and many people notice flares before their period. This pattern shows that hormones, especially androgens, may play a role in how often painful lumps appear.

If your symptoms worsen around your menstrual cycle, hormonal birth control may be considered. These medicines adjust hormone levels and may lower flare frequency in some women. Results vary because not all types work the same way.

Anti-androgen medicines are another option. These drugs reduce the effects of male-type hormones in your body, even if you are female. Lower hormone activity may decrease oil production and inflammation around hair follicles. Hormone treatment does not cure HS, but it may reduce the number and severity of flares over time.

10. Some Types of Cosmetics

Some cosmetics can irritate your skin and may trigger hidradenitis suppurativa flare-ups. This risk is higher in areas where your skin rubs together, such as your armpits, groin, under your breasts, or inner thighs. Sensitive skin in these areas can react more strongly to certain ingredients.

Products that clog hair follicles can raise your risk. Thick creams, heavy body butters, and oily lotions can trap sweat and bacteria against your skin. This buildup may increase the chance of painful lumps or abscesses. Fragranced products such as scented deodorants, perfumes, body sprays, and soaps can also cause redness, itching, or burning.

Some antiperspirants block sweat glands and may increase friction or irritation in people prone to HS. Shaving creams and hair removal products can cause small cuts that worsen symptoms. Makeup and powders used in skin folds may mix with sweat and block pores.

11. Improper Hair Tweezing

Improper hair tweezing can irritate your skin and damage hair follicles. When you pull hair out at the wrong angle or use unclean tools, the risk of inflammation increases. This irritation often affects areas where hidradenitis suppurativa appears, such as your armpits and groin.

Hair grows from small openings in your skin called follicles. Tweezing too often can cause the follicle to swell or become blocked. A blocked follicle can trap bacteria and debris, and this process may lead to painful lumps or abscesses in sensitive areas.

Aggressive tweezing can create tiny tears in the skin. These small breaks allow bacteria to enter and cause redness, swelling, and tenderness. Thick or coarse hair can grow back into the skin and cause ingrown hairs. Dull or unclean tweezers can spread bacteria and worsen inflammation in areas prone to flare-ups.

12. Hair Removal Products

Hair removal products can irritate your skin, especially in areas where hidradenitis suppurativa often develops. These areas include your armpits, groin, and under your breasts. The skin in these spots is thin and often rubs together, which makes it more sensitive to damage and inflammation.

Chemical depilators contain strong ingredients that break down hair. These chemicals can also harm the top layer of your skin. Irritated skin can cause hair follicles to swell or clog more easily. Shaving with a dull razor or shaving dry can create small cuts that lead to swelling around follicles.

Waxing removes hair from the root and can inflame the follicle and nearby skin. Tender skin or active sores may worsen after waxing. Some products contain fragrance, alcohol, or other harsh additives that increase redness and itching.

13. The Wrong Clothing

The clothes you wear can affect your skin more than you may think. Tight or rough fabrics rub against areas where hidradenitis suppurativa often forms, such as your armpits, groin, under your breasts, and buttocks. Constant rubbing in these areas can irritate sensitive hair follicles.

Friction from tight jeans, leggings, or fitted shirts can trap sweat and heat against your skin. Synthetic fabrics like polyester or nylon may hold in moisture. Common triggers include tight waistbands, underwire bras, shapewear, and thick seams that press into the skin. Blocked and irritated follicles can increase the risk of painful lumps.

Loose, soft clothing can lower friction and allow air to move across your skin. Natural fabrics such as cotton often absorb sweat better and reduce moisture buildup. Clothing alone does not cause hidradenitis suppurativa, but tight or non-breathable fabrics can worsen symptoms if you already have the condition.

14. Shaving with a Dull Razor Blade

Shaving with a dull razor blade can irritate your skin. When the blade is not sharp, it pulls on hair instead of cutting it cleanly. This extra friction can damage the skin around your hair follicles and increase irritation in sensitive areas.

Hidradenitis suppurativa often begins near blocked hair follicles. A worn blade can cause small cuts and ingrown hairs, which may clog follicles and lead to swelling or painful lumps. This problem is more common in areas such as your armpits, groin, and inner thighs where skin is delicate.

Tiny injuries may not be easy to see, but repeated shaving with a dull blade can stress your skin over time. Replacing razor blades often and limiting repeated strokes over the same area can help reduce irritation. Adjusting your shaving routine may help protect skin that is prone to flare-ups.