Have Both Hidradenitis Suppurativa and Psoriasis? A Guide to Natural Healing

From Hidradenitis Suppurativa to Psoriasis: Medicine, Science, Patients and Treatments

My name is Jaap, and I am a biomedical scientist that also used to live with severe Hidradenitis Suppurativa, the kind that takes over your life. Today, I am completely asymptomatic because I learned how to heal Hidradenitis Suppurativa from within. More importantly, I’ve had the privilege of helping many other individuals with HS get their lives back too.

For seven years, Hidradenitis Suppurativa (HS) was the defining battle of my life. The painful, draining lesions in my armpits and groin were a relentless source of physical and emotional torment. It was a lonely, frustrating war fought in silence. Then, just when I thought it couldn’t get any worse, something new and alarming appeared: angry, red, scaly patches started erupting on my arms and face. It was psoriasis.

I remember the profound sense of despair. Was my body just completely, irrevocably broken? It felt like a cruel joke. Not only had I already to endure the experience of walking with hidradenitis on my face for months, now I had to walk around with red silver scales… great… Fast forward many years, and a new client came to me for help through my community, HS Armor. She had battled HS for many years, and then she too developed psoriasis on her arms and face.

Right on the same locations as I experience it! This couldn’t be a coincidence. It was a pattern.

This post is our deep dive into this all aspects where hidradenitis suppurativa and psoriasis meet. We’re going to put on our scientist hats and our warrior armor to investigate the profound connection between these two conditions. We will look at the hard data, decode the complex immunology, listen to the voices of our fellow warriors, and most importantly, discover what this link means for the natural treatment of HS and our collective path to remission. If you’ve ever wondered how to treat Hidradenitis Suppurativa at its root naturally, understanding the connection between HS and psoriasis paves the way for this realization.

More Than a Hunch: The Scientific Proof of the HS-Psoriasis Link

For years, those of us living with both conditions felt like we were just unlucky. We were told they were two separate, unrelated diseases. But science has finally caught up to our lived experience.

A landmark population study published in 2023 by Kridin and his team looked at the health data of over 137,000 people.¹ What they found was staggering. The study revealed that patients with psoriasis have an

80% increased odds of also having Hidradenitis Suppurativa.¹

Let that sink in. It’s a massive, undeniable scientific validation of what my client and I, and so many others, have gone through. It’s not a coincidence. It’s a real, measurable connection.

The researchers also noted that patients who had both HS and psoriasis were more likely to be smokers and have a higher body mass index (BMI).¹

This statistical link has profound implications that are often overlooked in a typical doctor’s visit. If we know a psoriasis patient has a significantly higher risk of developing HS, why aren’t we proactively screening them or at least educating the patients so they can recognise the symptoms? Early-stage HS and psoriasis is far more manageable and can often be controlled before it progresses to the devastating stages. This failure to connect the dots represents a massive missed opportunity for preventative care and highlights the need for a more holistic view of these inflammatory conditions.

Inside the Immune Systems War: The Shared “Faulty Wiring”

So, what is this smoldering fire of inflammation? Why would it show up as deep, painful abscesses in one part of the body and as scaly plaques in another? The answer lies in the shared “faulty wiring” of our immune systems.

Recent research has pinpointed one of the primary component that leads to this mistakes in our body: a specific inflammatory pathway known as the IL−23/Th17 axis.¹

• Imagine your immune system oversimplified it consist of many different cells with different roles. Its job as network of different cells is to detect real threats and neutralize them.
• The cells communicate with each other trough various means but one crucial way to communicate is the release of signalling molecules. One of these signalling molecules is called Interleukin-23 (IL−23).
• These false alarms are picked up by a group guards called T-helper 17 (Th17) cells. Primed for a fight, they receive the signal from IL−23 and rush to the scene, and propagate and the inflammatory signal recruiting other immune cells to the scene.

The incredible thing is that it’s the exact same faulty signal strongly involved in both diseases.

• In Hidradenitis Suppurativa, the chaos erupts deep within the hair follicles of your armpits, groin, and other intertriginous areas, leading to the characteristic nodules and abscesses.³

Figure 1. Hidradenitis suppurativa lesions in the right axillary region of patient before treatment with tildrakizumab.

• In Psoriasis, that same chaos happens in the upper layers of the skin (the epidermis), causing skin cells to multiply uncontrollably, leading to the classic red, scaly plaques.²

It’s a very similar war, fought on two different battlefields that are both in the skin, one in the epidermis (the upper skin layer; psoriasis) and one in the dermis (lower layer of skin; HS). The microscopic images from skin biopsies, like those in a 2021 study by Ikeya et al., (shown below) are like satellite photos of these battlegrounds.⁴

What is also interesting is that when you analyse the histology (studying structures of cellular level) in both diseases the epidermis (upper top layer of the skin) skin is much thicker than in normal patients of even normal part of our skin that is not affected by hidradenitis suppurative in us HS patients. This can see in the image below. That is also why it does not go away quickly. It really alters the structure of the skin tissue and how the cells are organised, sadly, leaving lasting changes after every painful flair. An most effective long-term strategy for managing both hidradenitis suppurativa (HS) and psoriasis is to address the underlying inflammation at its source. At HS Armor, we focus on guiding patients through natural targeted approaches designed to interrupt the body’s inflammatory signals. This method has helped many of our clients significantly reduce their symptoms and achieve long-term remission.

Figure 2. Clinical and histological features of the patient with hidradenitis suppurativa (HS). (a) Eruptions of HS on the groin. (b) Psoriasiform plaques on the neck. (c–i) Histological features. (c) Histopathological features of the psoriasiform skin lesion on the neck (haematoxylin-eosin stain). Skin samples from the psoriasiform eruption on (e, h) the neck and (f, i) an HS lesion on the groin in the current patient and (d, g) a lesional skin sample from a control, non-tumour necrosis factor-α inhibitor-induced psoriasis vulgaris patient were stained with (d–f) anti-interleukin-17A antibodies and (g–i) anti-myxovirus resistance protein 1 antibodies. Scale bars: (c–i) 200 μm.

In that image the authors give us visual proof of this internal civil war, showing the tissue flooded with these inflammatory security signals that facilitate the communication between al the immune cells.

The Ultimate Betrayal: When Your Medication Makes Things Worse

Now we come to one of the most confusing and frustrating experiences an HS warrior can face. What happens when the very medication prescribed to help you actually triggers a new autoimmune disease? This isn’t a rare side effect; it’s a well-documented phenomenon called a “paradoxical reaction”.²

Specifically, powerful biologic drugs called TNF−α inhibitors (like Adalimumab), which are often used to treat both HS and psoriasis, can sometimes cause the very condition they’re meant to treat, or trigger a related one. We’ve seen cases where someone on Humira (Adalimumab) for HS suddenly develops psoriasis for the first time.²

How is this even possible? Let’s use another analogy: “Damming the River.”

• Think of the inflammatory cascade in your body as a powerful, raging river. Tumor Necrosis Factor-alpha (TNF−α) is one of the main, powerful channels this river flows through.
• A TNF−α inhibitor drug is like building a massive concrete dam across that specific channel. It’s very effective at stopping the flow of inflammation in that one path.
• But the pressure from the river (the root inflammation) doesn’t just disappear. The water has to go somewhere. It diverts, flooding its banks and carving out a new, unexpected channel.

In the case of paradoxical reactions, blocking the TNF−α pathway can cause a massive surge in a different inflammatory signal called Type-1 Interferon.⁴

The study by Ikeya et al. brilliantly proved this.⁴ They took biopsies from a patient who developed psoriasis while on a

TNF−α inhibitor for HS. When they stained the tissue samples, they found:

• The original HS lesion was high in IL−17A, a hallmark of that IL−23/Th17 pathway we talked about.
• The new, paradoxical psoriasis lesion was flooded with a protein called MxA, which is a direct, smoking-gun marker for high Type-1 Interferon activity.⁴

The existence of these paradoxical reactions is perhaps the ultimate evidence that hidradenitis suppurativa and psoriasis are two sides of the same coin. It shows that the immune system is a single, interconnected web. Pushing down hard on one pathway in this big interconnected web can alter the another pathway and in some cases leads to additional new symptoms.

This reality fundamentally challenges the narrow minded, symptom-suppressing approach of conventional medicine and points toward the need for a more holistic, systems-based solution. Pharmaceutical drugs have other problems such as they can build up tolerance, meaning they lose potency and also there are many other side effects, therefore the real solution is stopping the source of the inflammation. This is what we focus on everyday in the HS Armor community.

A Genetic Link to Autoinflammation in hidradenitis suppurativa and psoriasis

A scientific case report from 2021 gives us a fascinating look into the complex immune system imbalances that can occur in Hidradenitis Suppurativa¹. The study focused on a teenage boy with severe HS who was treated with adalimumab, a drug designed to block a key inflammatory molecule called

Tumor Necrosis Factor-alpha (TNF-α)². While on this treatment, he developed a new, psoriasis-like rash, a puzzling side effect known as a “paradoxical reaction”³. Researchers dug into his case to understand the genetic and molecular reasons behind this unexpected outcome.

One of the most interesting findings was a clue in the patient’s genetic code. He was found to have two rare variants in the MEFV gene, which is known to be involved in autoinflammatory diseases and also specifically in hidradenitis suppurativa and psoriasis ⁴.

The paper does not claim that these gene variants directly caused the reaction. Instead, the authors carefully suggest that the MEFV variants might have been a potential predisposing factor, making the patient more susceptible to both his underlying HS and the paradoxical reaction that followed⁵.

To understand what was happening inside the skin, the scientists analyzed tissue from both the original HS lesions and the new psoriasis-like rash. They discovered that two completely different inflammatory pathways were at play.

The original HS lesions showed high levels of Interleukin-17A (IL-17A), confirming its role in driving HS inflammation⁶. In contrast, the new psoriasis-like rash was flooded with a different protein called MxA⁷.

This is the crucial part of the story. MxA serves as a direct marker for the activity of another powerful inflammatory signal:

Type 1 Interferon (IFN)⁸. The study proposes that normally, TNF-α helps keep the production of Interferon-alpha (IFN-α) in check⁹. By using a drug to block TNF-α, this balance was disrupted, leading to an uncontrolled surge of IFN-α¹⁰. This excess interferon activity, clearly shown by the high MxA levels, is believed to be the pivotal event that triggered the paradoxical psoriasis-like reaction¹¹.

“the voices from patients”: having both hidradenitis suppurativa and psoriasis

Science provides the “what” and the “how,” but our shared stories provide the “we.” Hearing from others who walk the same path transforms data into solidarity. A recent Reddit discussion on this very topic shows just how common this experience is, validating everything the science tells us with raw honesty⁶

One patient noted the painful synergy between the two:

“When I have a flare of one now, I tend to have a flare of the other simultaneously”

Another unfortunate soul said this:

“Yeah. hs is an autoimmune thing too so many people get it as well as Psoriasis. Three people in my family with psoriasis also got hs.”

Many of us have felt uniquely broken by this double struggle. One comment perfectly captured this feeling of being singled out by fate:

“oh god I thought I was unlucky”.

The community, through shared experience, had already figured out the connection. As one person wrote:

“HS and Psoriasis are both Auto-immune dysfunctions… HS will pop up for people who already have an A-I, piggybacking on another condition”

“I have HS, psoriatic arthritis, and now I’m pretty sure I have inverse psoriasis! Who supersized my combo??”

“Yes, I think they are related somehow. I have had HS since puberty, several years before psoriasis. My armpits and groin have many scars.”

Navigating the Modern Treatment Maze for hidradenitis suppurativa and psoriasis

It’s crucial to acknowledge that modern pharmaceuticals, particularly biologics, can be powerful and life-saving tools. When the body’s inflammatory fire is raging out of control, these drugs can act as a vital shield, providing the breathing room needed to begin the deeper work of healing.

However, biologics are not a universal cure. They may not work for everyone, can have significant side effects, and will lose effectiveness over time as the body develops tolerance. While they are incredibly useful for managing severe symptoms, they do not address the root cause. The systemic imbalance in your body that results in Hidradenitis Suppurativa is driven by the same underlying inflammation that can manifest as psoriasis. 

This issue doesn’t stop with these two conditions; as long as the root cause remains unaddressed, new health problems will continue to appear. No drug or surgery can permanently stop this cycle.

Lasting health can only be achieved by healing the underlying inflammation. Therefore, natural interventions aimed at restoring the body’s internal balance should be a cornerstone of any treatment plan. Unfortunately, this foundational approach is almost entirely neglected by current medical standards.

A 2023 case report by Damsin et al. perfectly illustrates this dynamic. It details the story of a man with both severe HS and psoriasis who failed to respond to a TNF-α inhibitor (adalimumab) and an IL-17 inhibitor (secukinumab). He finally found significant relief with Tildrakizumab, a newer drug targeting IL-23 signaling molecule. This story offers hope and demonstrates the incredible progress of targeted therapies.

At the same time, it reveals the inherent limitations of a drug-centric approach. This patient had to cycle through several powerful medications to find one that worked, highlighting a frustrating game of immunological “whack-a-mole.” We suppress one inflammatory signal, only for the problem to pop up through another pathway. This is the endless loop of symptom management. And all while the internal root cause inflammation that leads to hidradentis suppurativa ans psoriasis is not resolved. On top of that his powerful working curing medication also comes with a powerful side effect.

Here is a simplified breakdown of the biologic drugs often used for HS and psoriasis, categorized by the inflammatory signal they block:

Biologic Class	Target (The “Signal” it Blocks)	Approved for Psoriasis?	Approved for Hidradenitis Suppurativa?	Key Examples
TNF-α Inhibitors	Tumor Necrosis Factor-alpha	Yes	Yes (Adalimumab)	Adalimumab, Infliximab, Etanercept
IL-17 Inhibitors	Interleukin-17A / IL-17 Receptor	Yes	Investigational	Secukinumab, Ixekizumab, Brodalumab
IL-12/23 Inhibitors	Interleukin-12 & Interleukin-23	Yes	Off-label use	Ustekinumab
IL-23 Inhibitors	Interleukin-23	Yes	Off-label use	Guselkumab, Risankizumab, Tildrakizumab

Ultimately, navigating this maze isn’t about choosing between modern medicine and natural healing, it’s about integrating the best of both. steroids, antibiotics, and biologics can be the powerful fire extinguisher that quells a dangerous flare, giving you space to breathe. But true, lasting health comes from addressing the source of the fire. By focusing on healing the root inflammation, you move beyond mere symptom management and toward the goal of lasting remission and genuine well-being.

The Two Paths Forward: Symptom Suppression vs. Foundational Healing

This brings us to the most important part of our journey. All the evidence, from the 137,000-person study, to the microscopic images of our skin, to the genetic clues in our DNA—points to one undeniable truth: HS and psoriasis are not two separate skin diseases. They are two different expressions of the same root problem: a dysregulated, over-reactive, and system-wide inflammatory state.

When you accept this truth, you realize you stand at a fork in the road. There are two paths you can choose.

Path 1: The Conventional Loop of Symptom Suppression.

This is the path most of us are placed on by default. It relies on using increasingly powerful drugs that serve as temporary “shields” to block the downstream signals of inflammation, but hey come with their own cost. This path is sometimes necessary to survive a crisis, but it never asks why the war is happening in the first place. It can lead to a demoralizing cycle of new drugs, mounting side effects, and confusing paradoxical reactions, because we are only ever chasing the smoke, never putting out the fire.

Path 2: The Foundational Healing Journey.

This is the HS Armor philosophy. On this path, we see pharmaceuticals as powerful but temporary tools, not the foundation of our health. The true, unshakable foundation of healing is built by systematically calming the entire immune system from the ground up. This means becoming a detective for your own body. It means meticulously identifying and removing your personal inflammatory triggers through diet. It means providing your body with the specific nutrients it’s screaming for to regulate inflammation. It means actively managing stress, which is a massive immune trigger, and using a wide variety of natural therapies practices that put out the fire at the stop the systemic root cause inflammation as well as promote wound and scar healing.

The ultimate goal of Path 2 is to build such a strong, resilient, and calm internal environment that . It’s about creating a body where the “shields” become less and less necessary, until one day, you realize you don’t need them at all. This is how we move from managing a disease to achieving true, lasting remission. This is how we treat hidradenitis suppurativa and psoriasis at HS Armor.

A scientific collection of case studies from patient with both hidradenitis suppurativa and psoriasis.

A narrative review of articles from 2017 to 2022 was conducted to analyze the link between hidradenitis suppurativa (HS) and psoriasis. The study identified 14 relevant papers, which included four case series and ten case reports. The analysis of these cases revealed key information about the clinical course, disease severity, and treatment outcomes for patients with both conditions.

The review found that most patients with both conditions first developed psoriasis before the onset of HS. However, a smaller number of cases showed the opposite, where HS developed before psoriasis. A significant finding was the occurrence of

paradoxical HS, where the condition was triggered by biological therapies used to treat psoriasis. These paradoxical reactions were noted with TNF-α blockers like adalimumab and infliximab, as well as with IL-12/23 and IL-17A inhibitors such as ustekinumab and secukinumab.

The study examined various treatments used for co-existing HS and psoriasis. Adalimumab, an anti-TNF-α agent, was shown to improve both conditions in some cases¹¹. Secukinumab, an IL-17A inhibitor, also demonstrated effectiveness. The review noted that other treatments, including IL-23 inhibitors (risankizumab) and IL-17 receptor blockers (brodalumab), showed promising results in non-responsive patients. Additionally, the PDE-4 inhibitor apremilast was presented as a valid alternative option, although with mixed results.

The study’s findings are summarized in a table and a figure that categorizes various drugs based on their approval status for HS and psoriasis.

Figure 1: Approved and On-Going Studied Biologic Treatments for HS and PsoriasisThe pyramid in the image categorizes a wide range of biologic treatments for psoriasis and hidradenitis suppurativa (HS) based on their level of evidence. The level of evidence is represented by the pyramid’s vertical axis, with case reports at the base (red), ongoing studies/clinical trials in the middle (yellow), and approval at the top (green/blue). The horizontal axis separates treatments primarily used for psoriasis on the left from those used for HS on the right^19191919.For psoriasis, the pyramid shows a greater number of treatments with higher levels of evidence, including approved drugs like adalimumab, certolizumab, ustekinumab, and guselkumab, as well as many others in clinical trials and case reports. In contrast, the section for HS has fewer approved drugs, with adalimumab being the only one approved by both the FDA and EMA for moderate to severe cases¹. The majority of other drugs for HS are still in clinical trials or have only been studied in case reports, highlighting a significant difference in therapeutic progress between the two diseases.

Key Takeaways

• Proven Link: Large-scale observation studies confirm that people with psoriasis have an 80% higher chance of having HS. It is not just a correlation, there are underlying mechanistic dysregulations that are shared by both hidradenitis suppurativa and psoriasis, it’s a scientifically validated connection.
• Shared Root Cause: Both HS and psoriasis are driven by the same underlying immune pathway, the IL−23/Th17 axis.
• Paradoxical Reactions: Paradoxical psoriasis is a reaction where a patient develops new or worsening psoriasis while on an anti-TNF-α biologic drug, which is a treatment often used for psoriasis itself and other autoimmune conditions. This is thought to occur because the drug, while blocking TNF-α, can disrupt the immune balance and trigger other inflammatory pathways that drive psoriasis.
• Your Bodies Critical Warning: Experiencing a second serious autoimmune or autoinflammatory disease can be your body’s critical warning sign. This signals a fundamental immune dysregulation, and it’s imperative to proactively address the root causes of chronic inflammation to prevent the progression and accumulation of further serious conditions. Autoimmune disease cause irreversible damage and destroy healthy tissue, the sooner you act the better your chances are to achieve long lasting remission.
• Real Long-Lasting Healing: True, long-term remission comes not from finding the perfect drug to suppress a signal, but from building a foundation of health (diet, lifestyle, natural therapies and practices) that calms the entire immune system at its source.

A Message of Hope

Healing from HS is is about taking back your power, learning the unique language of your body, and choosing to walk a different path. It’s a journey of rebuilding your health from the inside out, brick by brick.

This path can feel daunting, but you do not have to walk it alone. I invite you to join us in the HS Armor community, where we are all committed to walking Path 2. We share our knowledge, our struggles, and our victories, supporting each other on the journey to getting our lives back.

Remission is not a fantasy. It is possible. And it starts today.

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References

1. Kridin, K., Shani, M., Schonmann, Y., Fisher, S., Shalom, G., Comaneshter, D., Batat, E., & Cohen, A. D. (2023). Psoriasis and hidradenitis suppurativa: A large-scale population-based study. Journal of the American Academy of Dermatology, 88(5), e231-e236.
2. Macca, L., Li Pomi, F., Ingrasciotta, Y., Morrone, P., Trifirò, G., & Guarneri, C. (2023). Hidradenitis suppurativa and psoriasis: the odd couple. Frontiers in Medicine, 10, 1208817.
3. Damsin, T. (2023). A Case of Concurrent Psoriasis and Hidradenitis Suppurativa Successfully Treated with Tildrakizumab. Dermatology and Therapy, 13, 1611-1615.
4. Ikeya, S., Takeichi, T., Taki, T., Muro, Y., Ogi, T., & Akiyama, M. (2021). Paradoxical Reaction in a Patient with Hidradenitis Suppurativa Undergoing Adalimumab Treatment. Acta Dermato-Venereologica, 101, adv00484.
5. Reddit forum post about people with both Hidradenitis suppurativa and psoriasis. (User-provided document).
6. MEFV (Mediterranean fever). MedlinePlus. National Library of Medicine.
7. Jfri, A., Litvinov, I. V., Netchiporouk, E., & O’Brien, E. (2020). Novel variants of MEFV and NOD2 genes in familial hidradenitis suppurativa: A case report. SAGE Open Medical Case Reports, 8.

Important Medical Disclaimer

1. Not Medical Advice: All content and information on this website is for informational and educational purposes only. It does not constitute medical advice and is not a substitute for professional diagnosis, treatment, or consultation with a qualified healthcare provider.

2. My Role and Qualifications: I am a biomedical scientist and PhD candidate and share information from that perspective, combined with my personal experience as a patient with Hidradenitis Suppurativa. However, I am not a medical doctor, physician, or registered healthcare professional. Do not consider our relationship a doctor-patient relationship.

3. Consult Your Doctor: Always seek the advice of your medical doctor or another qualified health professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If you suspect you are experiencing a medical emergency, or a severe infection, do not rely on this website or the HS Armor community, please call your local emergency services or go to the nearest emergency room immediately.

4. A Critical Warning on Medication: Pharmaceutical drugs are a crucial tool in managing Hidradenitis Suppurativa for many people. Under absolutely no circumstances should you ever alter, reduce, or stop taking your prescribed medication without the explicit direction of the doctor who prescribed it. Doing so can be dangerous. Always consult with your doctor before doing anything related to your treatment plan.

5. No Liability: Your use of this website and reliance on any information provided is solely at your own risk.

6. Individual Results May Vary: Every patient’s biological baseline, genetics, and adherence to the protocol is different. Therefore, I cannot guarantee specific results, cures, or timelines for your Hidradenitis Suppurativa.

7. Scientific and Expressive Freedom: The articles published on this blog are distinct from formal peer-reviewed academic literature. They serve as an independent platform for my personal viewpoints, scientific hypotheses, and philosophical reflections as an independent scientist and HS patient. While grounded in biomedical research, I exercise a degree of expressive freedom to translate rigid academic data into insights from a patient perspective. These writings are my personal meditations on the science of HS and should be read as my individual perspective, not as universally accepted clinical consensus or formal peer-reviewed literature.