The well-established links between PCOS, obesity, insulin resistance, and elevated levels of systemic proinflammatory mediators, such as insulin-like growth factor 1 (IGF-1), leukotrienes, and long chain fatty acids (Penno et al., 2020), provide theoretical mechanisms as to how hormones may influence disease activity in HS; however, mechanistic evidence in HS is incomplete. This evidence concerns the gene IGF1 and Insulin resistance.