BACKGROUND: Select patients are diagnosed with both psoriasis (PSO) and hidradenitis suppurativa (HS), leading to a unique disease pattern. Genetic risk factors remain unidentified. METHODS: The study harnessed an international collection of patients with PSO and HS (PSO-SH). Clinical and genetic data were collected and analyzed. RESULTS: Eighty-seven PSO-SH patients (70% female) were identified. They had a high number of comorbidities (89%) and worse general physical health compared to PSO-only (OR: 3.09; 95% CI: 1.56-6.12) or HS-only (OR: 2.5; 95% CI: 1.23-5.00) patients. PSO-SH patients were at significantly higher risk of having Crohn's disease (OR: 4.6-11.9; 95% CI). Data revealed the highest overall genetic risk score for PSO-SH patients (PSO-polygenic risk score; 108.22), followed by PSO (101.18), HS (99.84), and healthy controls (98.58). High non-human leukocyte antigen scores were associated with an increased risk for developing both PSO and HS, indicating a distinct biological profile compared to HS-only and PSO-only individuals. LIMITATIONS: Some clinical information was collected retrospectively. CONCLUSIONS: This study highlights a shared genetic susceptibility of HS and PSO at non-human leukocyte antigen loci. Recognizing PSO-SH patients as a distinct patient group with high morbidity and increased risk for developing Crohn's disease will help to improve patient management.