Hidradenitis suppurativa (HS) is a chronic skin disease, characterized by clinical inflammation of the hair follicle with the recurrence of abscesses, nodules, and tunnels. Recently, several studies suggested a role of IL‐1 family (IL‐1F) cytokines in eliciting and sustaining the disease. The aim of this work is to perform a comprehensive analysis of IL‐1F cytokines, soluble inhibitors and receptors in a cohort of HS patients not treated with biological agents. Sixteen patients affected by HS and 16 healthy controls were recruited; clinical data were collected and disease severity evaluated by means of the International HS Severity Score System (IHS4). Serum levels of IL‐1F cytokines, inhibitors and receptors were measured using a Multiplex Assays. IL‐18 and free IL‐18 levels were significantly higher in patients vs controls. Among soluble inhibitors, IL‐1Ra, IL‐1R2 and ST2/IL‐1R4 were significantly increased. IL‐18, free IL‐18 and IL‐33 levels are strongly correlated with IHS4. Also the inhibitors IL‐1Ra and IL‐18BP show a correlation with IHS4. The data obtained in this study confirm the involvement of IL‐1F cytokines in mediating the disease and determining its severity and suggest a possible role for IL‐18 as novel serum biomarker of active disease.