The Role of Second to Fourth Digit Ratio in Hidradenitis Suppurativa: A Potential Link to Prenatal Hormonal Exposure

MUSTAFA ESEN , Abdullah Demirbaş, Esin Diremsizoglu

  • MUSTAFA ESEN: Dicle Üniversitesi Tıp Fakültesi
  • Abdullah Demirbaş: Kocaeli Üniversitesi Tıp Fakültesi
  • Esin Diremsizoglu: Kocaeli Üniversitesi Tıp Fakültesi
  • Year : 2025
  • Vol : 41
  • Issue : 4
  •  Page : 211-216
Objective: Hidradenitis Suppurativa (HS) is a chronic skin condition marked by inflammation and driven by diverse underlying mechanisms, including hormonal involvement. The second-to-fourth digit ratio (2D:4D) is an established marker of prenatal androgen exposure, which may contribute to HS susceptibility. The objective of this study was to explore the potential link between 2D:4D digit ratios and hidradenitis suppurativa, along with their correlation to disease severity.
Materials and Methods: A total of 140 HS cases and 140 healthy subjects matched by age and gender were enrolled in this cross-sectional investigation. Clinical severity was assessed using Hurley staging, the Modified Sartorius Score, and the Physician Global Assessment (PGA). Finger lengths were measured using a digital caliper, and 2D:4D ratios were calculated separately for each hand.
Results: HS patients had significantly lower 2D:4D ratios in both hands compared with controls (p < 0.001). In females, both left- and right-hand ratios were lower (p < 0.001), while in males only the left-hand ratio differed (p = 0.038). In female patients, the left-hand ratio correlated with disease severity measures, including Hurley stage, Modified Sartorius Score, and PGA (all p < 0.05).
Conclusion: Lower 2D:4D ratios, particularly in female HS patients, may reflect higher prenatal androgen exposure and be linked to greater disease severity. These findings support a possible hormonal contribution to HS pathogenesis, though confirmation in prospective studies with direct hormonal assessment is warranted. Interpretation is limited by the cross-sectional design. Additionally, the single-center setting and absence of biochemical hormone measurements may partly limit generalizability and the strength of disease mechanism–related interpretations.
Cite this Article As : Esen M, Demirbas A, Diremsizoglu E. Is Prenatal Sex Hormone Balance a Risk Factor for the Development of Hidradenitis Suppurativa? Selcuk Med J 2025;41(4): 211-216

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Conflict of interest : The authors declare that they have no conflict of interest.
This article is published under the CC BY-NC 4.0 license.
Selcuk Medical Journal
2025, Vol. 41 (4)
ISSN: 1017-6616
E-ISSN: 2149-8059
Received : , Accepted : , Published Online :

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