HS Disproportionately Affects Women — Here Are 4 Things To Know

Women’s health concerns have long been dismissed or downplayed — often attributed to anxiety, stress, or hormones instead of being investigated further. For people living with hidradenitis suppurativa (HS), that kind of dismissal can delay diagnosis and treatment for years.

HS is a chronic inflammatory skin condition that disproportionately affects women, yet many people have never heard of it until they’re diagnosed. Because awareness is the first step toward getting the care you deserve, here are four key things women should know about HS.

1. HS Causes Painful Bumps In Areas Where Skin Rubs Together

HS (also known as acne inversa) is a persistent inflammatory skin condition that causes painful, deep bumps that can resemble ingrown hairs or boils.

Board-certified dermatologist and founder of DermWorks, Jenna Queller, MD, FAAD, says the condition most often appears in areas where skin rubs together, including the underarms, groin, inner thighs, and beneath the breasts.

Without proper treatment, the lesions can worsen over time. “They may progress into draining abscesses, tunnels beneath the skin called sinus tracts, and permanent scarring,” Queller says. It’s not clear exactly how many people have HS, but it may be more common than many people realize. Experts estimate that as many as four in 100 people in the United States may be living with HS.

2. It’s Not Caused By Poor Hygiene

One of the most harmful myths about HS is that it’s related to hygiene — it’s not. This misconception can be especially damaging for women, who often face greater societal pressure around cleanliness and body care, leading to unnecessary shame or delayed diagnosis.

Instead, the condition begins when a hair follicle becomes blocked, triggering an exaggerated inflammatory response from the immune system. HS is also not contagious.

The exact reason follicles become blocked isn’t fully understood, but several factors may play a role. According to Queller, these include “genetics, hormonal influences, smoking, and metabolic factors such as obesity.”

Hormones, in particular, may help explain why HS disproportionately affects women. Some patients notice flare-ups around their menstrual cycle, suggesting that hormonal fluctuations can play a significant role in disease activity.

3. Women Are More Likely To Have It

In the United States, women are diagnosed with HS about three times more often than men. Queller notes that HS has been linked to hormonal conditions like polycystic ovarian syndrome (PCOS), which may partly explain the higher diagnosis rates in women. She adds that in women specifically, the inframammary folds (the creases beneath the breasts) are commonly affected.

Another factor may simply be that women are more likely to seek medical care, which could lead to higher diagnosis rates.

4. HS Is Often Misdiagnosed Or Diagnosed Late

Because HS can resemble other skin issues — including cysts, ingrown hairs, or boils — it’s frequently misdiagnosed. For women, this confusion is often compounded by the areas where HS appears, such as the groin or beneath the breasts, where symptoms may be mistaken for shaving irritation, folliculitis, or hormonal breakouts.

There’s also no single test that confirms it. Instead, dermatologists diagnose HS based on a pattern of symptoms: recurrent painful nodules or abscesses in typical locations and a history of flare-ups over time. Women may also face delays in diagnosis because symptoms are sometimes dismissed as routine skin concerns or tied to menstrual or hormonal changes. In some cases, discomfort discussing symptoms in intimate areas can further slow down getting an accurate diagnosis.

In more advanced cases, imaging may be used to evaluate deeper inflammation, but most diagnoses are made through a physical exam and medical history.

The Bottom Line

Living with HS can be physically painful and emotionally challenging — especially when symptoms are misunderstood or dismissed. But there is good news: Treatment options are expanding, and awareness of the condition is growing.

“For women living with HS, it’s important to understand that this is not something you caused, and you are not alone,” says Queller. Early diagnosis and treatment can help prevent disease progression and scarring.

“We now have more effective treatment options than ever before,” she adds. “With the right approach, this condition can be managed successfully.”

Presented by BDG Studios