Hidradenitis suppurativa: pathogenesis

Hidradenitis suppurativa (HS), also known as Verneuil’s disease, is a prevalent and chronic skin inflammatory disorder that often causes significant disability. It is estimated to affect approximately 1-2% of the population in Western countries [1]. Flares of HS are characterized by the development of painful and purulent lesions in skin folds, such as the armpits, inguinal folds, and sub-mammary areas. The cutaneous lesions associated with HS progress in severity, from folliculitis to nodules, abscesses, and ultimately fistulas. All these skin manifestations are accompanied by painful suppurations, creating a considerable burden for patients [1]. Although the exact pathogenesis of HS remains poorly understood, the positive response of patients to combinations of antibiotics and immunosuppressive treatments suggests that the disease may be related to a dysregulated immune response against the cutaneous microbial flora. Here we will review the current knowledge regarding HS pathogenesis and the complex interplay of genetic, environmental and immunological factors. Finally, we will discuss the concept of window of opportunity in HS, and the data suggesting that early diagnosis and treatment are essential in HS.
Several environmental factors have been associated with HS, with smoking and obesity repeatedly reported as contributing to increased disease severity. A high prevalence of cannabis smoking was also reported in HS patients, but with no link to disease severity [2].
Smoking has been unanimously reported as a risk-factor for HS [3]…