Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarilyaffecting apocrine gland-rich areas of the body and presenting with painful nodules, abscesses,sinus tracts, and scarring. HS is a multifactorial disease in which genetic and environmentalfactors play a key role. The primary defect in HS pathophysiology involves follicular occlusionof the folliculopilosebaceous unit, followed by follicular rupture, and immune responses(perifollicular lympho-histiocytic inflammation), finally leading to the development of clinicalHS lesions. HS has a destructive impact on the patient’s quality of life, being a very challengingdisease. Available treatments are limited, mostly off-label and with high variability in thereported efficacy. Fortunately, a monoclonal antibody against tumor necrosis factor alpha hasbeen recently approved for treatment of moderate to severe HS, offering patients a promisingnew option. This review focuses on the main features of HS, including epidemiology, clinicalaspects, pathogenesis, severity classifications, comorbidities, and currently available treatments.