Hidradenitis suppurativa, often shortened to HS, is one of those skin conditions that sounds like it belongs in a medical spelling bee, but for people who live with it, the problem is painfully real. HS causes recurring, tender bumps under the skin, often in places where skin rubs together: the armpits, groin, inner thighs, buttocks, under the breasts, and sometimes around the waistline. These bumps can look like boils or deep acne, but HS is not ordinary acne, and it is definitely not a sign that someone skipped shower day.
The big question is: who gets hidradenitis suppurativa? The answer is not as simple as pointing to one age group, one body type, or one lifestyle habit. HS can affect different kinds of people, but research shows certain groups are more likely to develop it. Genetics, hormones, immune system activity, smoking, body weight, skin friction, and related inflammatory conditions can all play a role. In other words, HS is not a character flaw; it is a complex inflammatory skin disease with a complicated guest list.
This guide explains who is most at risk, why HS often appears when it does, what factors may increase the chance of flare-ups, and why early diagnosis matters. Let’s clear up the confusion, minus the shame and medical fog machine.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa is a chronic inflammatory skin condition that begins around hair follicles. When these follicles become blocked and inflamed, painful nodules can develop beneath the skin. Over time, some bumps may open, drain fluid, form abscesses, leave scars, or create tunnel-like connections under the skin called sinus tracts.
HS most often shows up in areas with sweat glands and skin folds, but it is not caused by sweat alone. It is also not caused by being dirty, using the wrong soap, or failing to scrub hard enough. In fact, aggressive scrubbing can irritate the skin and make things worse. HS is also not contagious, so you cannot catch it from hugging, sharing a towel, sitting on the same chair, or borrowing someone’s hoodie. The hoodie may be questionable for other reasons, but HS is not one of them.
Who Is Most Likely to Get Hidradenitis Suppurativa?
Anyone can develop HS, but some patterns appear again and again in medical research. The condition often begins after puberty and is most commonly diagnosed in young adults. It is more frequently reported in women than men, and studies in the United States show a higher burden among Black patients compared with white patients. Family history, smoking, obesity, and certain medical conditions may also increase risk.
These risk factors do not mean someone “caused” their HS. They simply help explain why one person may develop the condition while another person does not. Think of HS as a puzzle with several pieces, not a single on/off switch.
1. People in Their Teens, 20s, and 30s
HS often begins after puberty, which suggests hormones may influence the disease. Many people notice their first symptoms in late adolescence or early adulthood, sometimes years before getting the right diagnosis. Unfortunately, because HS can resemble boils, ingrown hairs, acne, or infected cysts, it is commonly misidentified at first.
A person may spend years being told, “It is just a boil,” only to have the same painful lump return like a bad sequel nobody asked for. Early diagnosis matters because treatment can help reduce flares, manage pain, and prevent scarring or tunnels from becoming more advanced.
2. Women and People Assigned Female at Birth
HS is reported more often in women than in men. Hormonal shifts may help explain part of this pattern. Some people notice flares around menstrual cycles, during times of hormonal change, or in connection with conditions such as polycystic ovary syndrome, also known as PCOS.
That does not mean HS is only a “women’s condition.” Men can absolutely develop HS, and some studies suggest men may be more likely to have certain patterns of disease, such as involvement around the buttocks or perianal area. The main point is that sex and hormones appear to influence risk and symptom patterns, but they do not tell the whole story.
3. People With a Family History of HS
If a parent, sibling, or close relative has hidradenitis suppurativa, your risk may be higher. Many people with HS report that someone else in the family had similar “boils,” painful bumps, or scarring, even if that relative never received an official diagnosis.
Genetics may affect how hair follicles behave, how inflammation is triggered, or how the immune system responds in the skin. Still, family history is not destiny. Some people with HS have no known relatives with the condition, while others may carry a higher risk and never develop symptoms. Genes may load the dice, but they do not always roll them.
4. People Who Smoke
Smoking is one of the strongest lifestyle-related factors associated with HS. Many people diagnosed with HS have a history of cigarette smoking, and smoking may influence inflammation, follicle blockage, and immune activity in the skin.
This does not mean every smoker will get HS, and it does not mean people who never smoke are protected. However, for people who already have HS, quitting smoking may be one helpful part of a broader management plan. It is not a magic wand, because skin diseases rarely respect magic wands, but it can support better overall health and may reduce triggers for some people.
5. People With Higher Body Weight or More Skin Friction
Obesity is associated with a higher risk of HS and more severe symptoms in some people. Several reasons may help explain this connection. More skin folds can create more friction, heat, and moisture. Fat tissue can also contribute to systemic inflammation, which may worsen inflammatory diseases.
This topic deserves compassion. HS is painful, and pain can make exercise difficult. Draining wounds can make people avoid gyms, pools, or fitted clothing. Fatigue and embarrassment can make movement feel like a public performance nobody signed up for. So while weight management may help some people, advice should be realistic, respectful, and medically guided.
6. Black Patients and Other Underserved Groups
In the United States, HS appears to disproportionately affect Black patients, and some research suggests Black patients may experience more severe disease or delays in access to specialty care. This matters because HS is already underdiagnosed, and delays can lead to years of pain, scarring, and emotional stress.
Disparities in diagnosis and treatment can happen for many reasons, including limited access to dermatologists, differences in how symptoms are interpreted, lack of awareness, and historical inequities in health care. Better education for patients and clinicians can help close this gap. Painful recurring lumps in skin folds should be taken seriously in every skin tone.
Medical Conditions Linked With HS
HS is more than a skin-deep inconvenience. It is an inflammatory disease and may be associated with other health conditions. Not everyone with HS has these conditions, but clinicians often watch for them because they can affect treatment and long-term health.
Inflammatory Bowel Disease
Some people with HS also have inflammatory bowel disease, especially Crohn’s disease. Both conditions involve immune system activity and inflammation, and certain treatments may overlap. If someone has HS plus chronic diarrhea, abdominal pain, blood in the stool, or unexplained weight loss, it is worth discussing those symptoms with a healthcare professional.
Metabolic Syndrome, Diabetes, and Heart Health
HS has been linked with metabolic syndrome, type 2 diabetes, high blood pressure, cholesterol problems, and cardiovascular risk factors. Chronic inflammation may be one reason for this connection. Because of this, people with HS may benefit from regular checkups that include blood pressure, blood sugar, and cholesterol screening.
PCOS and Hormonal Conditions
PCOS may be more common among people with HS. Signs of PCOS can include irregular periods, acne, excess facial or body hair, and insulin resistance. For people who notice HS flares around hormonal changes, a dermatologist may work with a primary care doctor, gynecologist, or endocrinologist to create a more complete care plan.
Depression and Anxiety
HS can affect mental health in a very real way. Pain, odor, drainage, scarring, and the unpredictability of flares can make people avoid social events, intimacy, exercise, or even sitting comfortably at work. Anxiety and depression are not “overreactions” to HS. They are common responses to a chronic condition that often hides under clothing but takes up a lot of emotional space.
Common Myths About Who Gets HS
Myth: Only People With Poor Hygiene Get HS
False. HS is not caused by being unclean. People with HS are often extremely careful about hygiene because they are trying to manage pain, drainage, and odor. Blaming hygiene only adds shame and delays proper care.
Myth: HS Is Just Bad Acne
False. HS can look acne-like, but it is a distinct inflammatory condition. It often occurs in skin folds rather than only on the face, chest, or back. It can also cause tunnels and scarring that ordinary acne does not.
Myth: HS Is Contagious
False. You cannot catch HS from another person. Draining lesions may need proper wound care, but the disease itself does not spread through casual contact.
Myth: Thin People Do Not Get HS
False. Higher body weight may raise risk or severity for some people, but HS can affect people of any size. A thin person with recurring painful lumps in the armpits or groin still deserves evaluation.
How HS May Look in Real Life
HS does not always arrive dramatically. In the beginning, it may look like a tender pea-sized bump under the skin. A person might blame shaving, tight jeans, a sweaty workout, or an ingrown hair. Then the bump returns in the same area. Or another appears nearby. It may swell, throb, drain, heal, scar, and come back again.
Some people have mild HS with occasional bumps. Others develop frequent flares, painful abscesses, scarring, and tunnels that limit movement. HS can make it hard to raise an arm, walk comfortably, sit for long periods, or wear certain clothing. A seam that once felt harmless can suddenly feel like it was designed by a villain with a zipper obsession.
When to See a Doctor
It may be time to see a healthcare professional, ideally a dermatologist, if you have painful lumps that return in the same areas, bumps that drain fluid or pus, scarring in the armpits or groin, or “boils” that keep coming back. You should also seek care if symptoms interfere with sleep, work, movement, intimacy, or mood.
There is no single test for HS. Diagnosis is usually based on the pattern of symptoms, location, recurrence, and physical exam. A dermatologist may ask how often flares happen, where they occur, whether anyone in the family has similar symptoms, and whether triggers such as periods, stress, heat, sweating, or friction seem involved.
Can HS Be Prevented?
There is no guaranteed way to prevent HS, especially when genetics and immune activity are involved. However, people at risk may be able to reduce flares or severity by managing known triggers. This may include quitting smoking, reducing friction, wearing breathable clothing, treating related conditions, maintaining a comfortable weight when possible, and getting medical care early.
Importantly, lifestyle changes should not replace medical treatment. HS may require topical medications, oral antibiotics, hormonal therapies, biologic medications, steroid injections, laser hair reduction, procedures, surgery, or wound care. The best plan depends on severity, location, personal health history, and how HS affects daily life.
Practical Tips for People at Higher Risk
If you are at higher risk for HS because of family history, previous symptoms, smoking, obesity, PCOS, inflammatory bowel disease, or repeated “boils,” awareness is your best first tool. Pay attention to recurring patterns. A single bump may not mean HS, but repeated painful lumps in the same friction-prone areas deserve attention.
Choose loose, breathable clothing when possible. Avoid shaving directly over active flares. Do not squeeze or pop deep nodules, because that can increase inflammation and scarring. Warm compresses may help discomfort, but persistent or severe lesions need medical guidance. Keep a symptom diary that notes location, timing, pain level, menstrual cycle, stress, foods, heat exposure, and clothing friction. This can help your clinician spot patterns faster.
Conclusion: HS Can Affect Many People, But Risk Is Not Random
Hidradenitis suppurativa can affect people of different ages, sizes, races, and lifestyles, but it is more common in certain groups. It often begins after puberty, appears more frequently in women, may run in families, and is associated with smoking, obesity, skin friction, hormonal factors, and inflammatory or metabolic conditions. In the United States, Black patients appear to carry a higher burden and may face additional barriers to timely care.
The most important takeaway is simple: HS is not your fault. It is not caused by poor hygiene, and it is not contagious. If painful lumps keep returning in skin-fold areas, getting evaluated early can make a major difference. HS may be stubborn, but with the right diagnosis, treatment, and support, people can reduce flares, protect their skin, and reclaim comfort in daily life.
Experiences Related to Hidradenitis Suppurativa: Who Gets It?
Living with HS often begins with confusion. Many people remember the first bump as something small and easy to dismiss. Maybe it appeared after a hot day, a workout, a long shift, or a pair of jeans that looked fantastic but behaved like sandpaper. At first, it seemed like an ingrown hair or a random boil. Then it returned. Or another one appeared. Eventually, the pattern became too obvious to ignore.
One common experience is the long road to diagnosis. A person may visit urgent care several times and receive antibiotics for “infection,” only for the lump to come back weeks later. Another person may be told to wash better, lose weight, change deodorant, or stop shaving. Some of that advice may help irritation, but it misses the bigger point: HS is an inflammatory disease, not a cleanliness report card. Being misunderstood can feel almost as painful as the flare itself.
People with HS also learn to plan around their skin. Clothing becomes strategy. Soft waistbands, breathable underwear, loose sleeves, seamless bras, and dark fabrics can become part of the survival kit. A person may carry gauze, extra dressings, pain relievers, or a backup shirt. This is not drama; it is preparation. HS can drain unexpectedly, and nobody wants a surprise wound-care situation between lunch and a staff meeting.
The emotional side is often quiet but heavy. HS affects areas of the body people are taught to keep private, which can create shame. Dating, intimacy, swimming, gym workouts, and even routine doctor visits may feel stressful. Someone may worry about odor, scars, or how to explain a bandage. The condition can make people feel isolated, especially when friends have never heard of it. It is hard to explain a disease that hides under clothing but loudly interrupts your day.
There is also the frustration of unpredictability. A flare can appear before a vacation, wedding, job interview, or first date, because apparently HS has terrible manners. Triggers vary from person to person. For some, heat and sweating make symptoms worse. For others, friction, stress, menstrual cycles, or certain foods seem connected. Many people become detectives of their own bodies, tracking patterns and learning what helps.
On the hopeful side, getting the right diagnosis can be life-changing. A dermatologist who recognizes HS can offer treatment options, explain stages, screen for related conditions, and help reduce flares. Support groups and online communities can also help people feel less alone. Hearing “me too” from someone who truly understands can lift a weight that no ointment can reach.
The experience of HS is different for everyone, but one truth is shared: people with HS deserve compassion, accurate information, and medical care without blame. Whether someone is a teenager with early symptoms, a parent who finally recognizes a family pattern, or an adult who has spent years being misdiagnosed, their pain is valid. HS may choose its targets through a mix of genetics, inflammation, hormones, environment, and chance, but people can choose knowledge, support, and treatment. That choice matters.
