Hidradenitis suppurativa (HS) is a chronic disabling inflammatory disease of the follicular unit especially affecting apocrine gland-bearing skin areas. Little is known about systemic inflammatory complications of the disease. This study aimed to evaluate systemic inflammation in patients with HS by assessing serum amyloid A protein (SAA) and C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) and to identify potential risk factors for HS. Forty-four patients (M/F: 28/16) and 44 age- and sex-matched controls (M/F: 28/16) were enrolled. Demographic, clinical, laboratory, and therapeutic data, including smoking status, body mass index (BMI), waist circumference (WC), serum fasting lipid profile, fasting blood glucose, SAA, and CRP levels, and ESR were assessed. Associations were investigated by univariate and multivariate analyses. Patients with HS showed significantly higher levels of pack-years of cigarette smoking, weight, BMI, and WC (P = 0.01, P < 0.001, P = 0.001) and elevated SAA and CRP levels and ESR (P = 0.008, P = 0.01 and P < 0.001). SAA and CRP levels and ESR were significantly associated with Hurley staging in patients with HS (P = 0.03, P = 0.003, P = 0.02). Multivariate logistic regression analysis revealed that each unit increase in the ESR increased the HS risk by 1.08-fold (95% CI 1.02-1.13). HS is significantly associated with SAA, CRP, and ESR. Among these inflammatory parameters, ESR was an independent risk factor for HS. We recommend assessment of SAA, CRP, and ESR as biomarkers that reflect the disease severity in HS patients likely to develop complications.