Background: Recent studies have shown a relationship between hidradenitis suppurativa (HS) and metabolic syndrome (MS), but the literature offers no meta-analysis restricted to studies that have been adjusted for confounders. Objective: To determine the association between HS and MS. Methods: A systematic review and meta-analysis of observational studies on HS and MS in adults. We searched MEDLINE, SCOPUS, SCIELO, Google Scholar, Science Direct, and LILACS from the inception of the databases to January 2016. We performed a random effects model meta-analysis for studies reporting adjusted and crude odds ratios (ORs) with 95% CIs. A subgroup analysis was related to the type of HS patient (general patients vs hospital patients) and age group (adults vs children and adults). Results: Five studies including 3950 HS patients were analyzed. We found that MS was pres-ent in 9.64% of HS patients (OR, 1.82; 95%, CI 1.39–2.25). Studies from tertiary care hospital dermatology clinics (OR, 2.82; 95% CI, 0.58–5.06) reported a greater risk for MS than studies carried out in patients treated outside hospitals (OR, 1.78; 95% CI, 1.34–2.22). Studies that included pediatric populations reported a significant association (OR, 2.10; 95% CI, 1.58–2.62). Limitation: Few of the included studies reported adjusted ORs. Conclusions: HS patients have an increased risk for MS. Clinicians should consider screening HS patients for metabolic risk factors.