Introduction: Hidradenitis suppurativa (HS) is a severe chronic inflammatory skin disease. Although the pathogenesis remains unclear, at the basis of HS there is an enhancement of the immune and inflammatory response together with a susceptibility to environmental factors. Cytokines dysregulation is crucial in HS severity and progression. Objectives: the aim of this study was to analyze serum levels of different cytokines focusing on adiponectin concentration and its oligomeric distribution in serum from HS patients compared to both obese and healthy subjects. Methods: The concentrations of adiponectin and cytokines were measured using ELISA assay; the oligomeric distribution of adiponectin was evaluated through Western Blotting analysis. Results: Total Adiponectin is statistically higher in HS patients compared to matched controls (28.54 ±4.49μg/mL vs 24.67±3.35 μg/mL, p=0.00). Interestingly, Adiponectin oligomerization state is altered in HS, with an increase of HMW oligomers. Serum levels of PDGF-BB, IL-1b, IL-5, Il-6, IL12, IL13, IL15, IL-17, GMCSF, INFg, VEGF and MCP-1 are statistically higher while IL-1ra and RANTES levels are statistically lower in HS patients compared to healthy controls. Interestingly, adiponectin positively correlates with PDGF-BB, and IL-13. Conclusions: HS patients have a dysregulated immune homeostasis correlated with altered metabolism. Indeed, our data suggest that Adiponectin and its HMW oligomers are involved in HS representing a potential biomarker of disease. In particular, the specific correlation of adiponectin with PDGF-BB, and IL-13 extends its role in modulation of immune responses suggesting that this adipokine might act regulating the innate immune system rather that the adaptive one.