Background: Hidradenitis suppurativa (HS) is a debilitating chronic disease that leads to inflammation and abscess formation in the involved skin, along with a malodorous discharge. Pain is a considerable aspect of HS and significantly impacts quality of life. In addition, HS is significantly associated with depression. A better understanding of contributing factors to depression and pain in patients with HS can identify opportunities to improve care for patients. Objective: To identify factors that contribute to depression and chronic pain in patients with HS. Methods: This is a retrospective chart review of 283 patients seen at dermatology clinics of an academic health center for HS from July 2012 to December 2015. The association between HS and depression and chronic pain was assessed in multivariate models using logistic regression analyses. Results: Patients with a greater number of areas of involvement were more likely to have both chronic pain and depression. Limitations: This is a single-center retrospective chart review with a limited sample size. Conclusion: This study suggests that the extent of disease rather than severity plays a role in reducing the quality of life in HS patients.