Background The association between chronic inflammatory diseases, such as rheumatoid arthritis and psoriasis, and insulin resistance (IR) has been well established. Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease that affects the apocrine gland‐bearing areas of the body. Objective We aimed to determine the prevalence of IR in patients with HS. Methods This cross‐sectional, case–control study enrolled 137 subjects, 76 patients with HS and 61 age‐ and gender‐matched controls. Demographic data, clinical examination of HS patients, anthropometric measures, cardiovascular risk factors and laboratory studies were recorded. The homeostasis model assessment of IR (HOMA‐IR) was calculated in all participants by measuring fasting plasma glucose and insulin levels. Results The median (IQR) HOMA‐IR value in HS patients was significantly higher 2.0 (1.0–3.6) than in controls 1.5 (0.9–2.3) (P = 0.01). The prevalence of IR was significantly higher in cases (43.4%) compared with controls (16.4%) (P = 0.001). In the linear regression multivariable analysis after adjusting for age, sex and body mass index (BMI), HS remained as a significant factor for a higher HOMA‐IR 2.51 (0.18) vs 1.92(0.21); P = 0.04. The HOMA‐IR value and the prevalence of IR did not differ significantly among HS patients grouped by severity of the disease. Conclusion Our results show an increased frequency of IR in HS. Thus, we suggest HS patients to be evaluated for IR and managed accordingly.