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Feature Article

Hidradenitis suppurativa: what’s new in pathogenesis and management

KIRSTY J.L. WARK, GEOFFREY D. CAINS

Figures

© nebari/stock.adobe.com model used for illustrative purposes only
© nebari/stock.adobe.com model used for illustrative purposes only

Abstract

Hidradenitis suppurativa is a chronic autoinflammatory skin condition with significant comorbidities. Advances in our understanding of  its pathogenesis are leading to new potential treatments.

Key Points

  • Hidradenitis suppurativa (HS) is an autoinflammatory skin condition involving the innate immune system.
  • The pathogenesis of HS is not fully understood; inflammation has been regarded as secondary to follicular occlusion but is now considered the likely initial event.
  • Genetics, the skin and gut microbiome and biofilms are also likely to play significant roles in HS pathogenesis.
  • HS is part of the follicular occlusion tetrad, and evidence is emerging that the other members (acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus) are anatomical variants of HS.
  • Biologics such as interleukin-23 and interleukin-1 are emerging off-label treatments for patients with HS, although large-scale randomised clinical trials are lacking.

Figures

© nebari/stock.adobe.com model used for illustrative purposes only
© nebari/stock.adobe.com model used for illustrative purposes only