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Review
. 2025 Feb 1;405(10476):420-438.
doi: 10.1016/S0140-6736(24)02475-9. Epub 2025 Jan 22.

Hidradenitis suppurativa

Robert Sabat  1 , Afsaneh Alavi  2 , Kerstin Wolk  3 , Ximena Wortsman  4 , Barry McGrath  5 , Amit Garg  6 , Jacek C Szepietowski  7
Affiliations
Free article
Review

Hidradenitis suppurativa

Robert Sabat et al. Lancet. .
Free article

Abstract

Hidradenitis suppurativa is a chronic inflammatory disease characterised by painful, deep-seated nodules, abscesses, and draining tunnels in the skin of axillary, inguinal, genitoanal, or inframammary areas. In recent years, the body of knowledge in hidradenitis suppurativa has advanced greatly. This disorder typically starts in the second or third decade of life. The average worldwide prevalence is 1% but varies geographically. Hidradenitis suppurativa has a profound negative effect on patients' quality of life and on the gross value added to society. Comorbidities (eg, metabolic syndrome, inflammatory arthritis, and inflammatory bowel disease) frequently accompany skin alterations, because of systemic inflammation. Pathogenesis of hidradenitis suppurativa is complex and includes innate immune mechanisms (eg, macrophages, neutrophils, IL-1β, tumour necrosis factor [TNF], and granulocyte colony-stimulating factor), T-cell mechanisms (eg, IL-17 and IFN-γ), and B-cell mechanisms (eg, associated with dermal tertiary lymphatic structures and autoantibodies). Chronic inflammation leads to irreversible skin damage with tunnel formation and morbid scarring. Current treatment includes drug therapy (for the initial, purely inflammatory phase), combined drug and surgical therapy (for the destructive phase), or surgery alone (for the burnout phase). The first systemic therapies approved for hidradenitis suppurativa targeting TNF (adalimumab) and IL-17 (secukinumab and bimekizumab) have expanded drug therapy options for moderate-to-severe disease, which were previously mainly restricted to oral antibiotics. Moreover, there is a robust pipeline of immunomodulatory drugs in various stages of development for hidradenitis suppurativa. Aims of management should include early intervention to prevent irreversible skin damage, adequate control of symptoms including pain, and mitigation of extra-cutaneous comorbidities, all requiring early diagnosis and an interdisciplinary, holistic and personalised approach.

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Conflict of interest statement

Declaration of interests RS received research grants or clinical trial contracts from AbbVie, Boehringer Ingelheim Pharma, Celgene/Amgen, Celgene/Bristol Myers Squibb, Charité Research Organization, CSL Behring, ICON, IQVIA RDS, Incyte, Janssen-Cilag/Janssen Research & Development, MoonLake Immunotherapeutics, Novartis, Parexel, Rheinischen Friedrich-Wilhelms-Universität Bonn, Sanofi Aventis, TFS, and UCB Biopharma paid to their institution; honoraria for lectures, consulting, or participation in advisory boards from AbbVie, Almirall Hermal, Amgen, Bayer Schering Pharma, Bruno Bloch Stiftung, Janssen-Cilag/Janssen Research & Development, Novartis, UCB Biopharma, Universitätsmedizin Greifswald, and Wundnetz Berlin-Brandenburg; and is a member of the International Psoriasis Council (unpaid) and speaker of psoriasis group of the German Consortium for Dermatological Research (unpaid). AA received a National Institutes of Health grant on severe drug reactions paid to their institution; honoraria for consulting or participation in advisory boards from AbbVie, Almirall Hermal, Boehringer Ingelheim, Incyte, InflaRx, Leo, Novartis, Sanofi, and UCB Biopharma; was Principal Investigator in clinical trials for Boehringer Ingelheim and Processa Pharmaceuticals and paid to their institution; and was a board member of the Hidradenitis Suppurativa Foundation. KW reports research grants from Celgene/Amgen, Bristol Myers Squibb, Charité Research Organization, Janssen-Cilag, Novartis, Sanofi Aventis, and TFS Trial Form Support paid to their institution; honoraria for lectures, consulting, or participation in advisory boards from Janssen-Cilag, Novartis, Sanofi Aventis, and University Hospital Magdeburg; support for attending meetings from the European HS foundation (EHSF) and the Symposium on Hidradenitis Suppurativa Advances (SHSA); is recipient of a poster prize awarded from the EHSF at its annual symposium; and is speaker for the HS group of the German Consortium for Dermatological Research (unpaid). XW received royalties from Springer Books; medical writing support from Novartis Pharmaceutical; honoraria for lectures from Novartis and UCB Biopharma; and is a member of the editorial board of the Journal of Ultrasound in Medicine, the Journal of the American Academy of Dermatology International, and Skin Research and Technology (unpaid). BM received honoraria for consulting from Incyte; honoraria for consulting, participation in steering committees or advisory boards, speaking engagements, and educational events from Novartis and UCB Biopharma; support for attending meetings from Novartis and UCB Biopharma; and is a board member of the advocacy group HS Ireland (unpaid). AG received research grants from AbbVie, UCB Biopharma, and the CHORD COUSIN Collaboration; honoraria for consulting or participation in advisory boards from AbbVie, Boehringer Ingelheim, Incyte, Insmed, Novartis, Pfizer, Sonoma Biotherapeutics, Sun Pharma, UCB Biopharma, Union Therapeutics, and Zura Bio; honoraria for participation on data a safety monitoring board from Sanofi; is co-copyright holder of the HS-IGA and HiSQOL instruments (paid to institution); and a member of the editorial board of the Journal of the American Academy of Dermatology (unpaid). JCS received honoraria for consulting or lectures from AbbVie, Almirall Hermal, Boehringer Ingelheim, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pierre Fabre, Pfizer, Sandoz, Sanofi Genzyme, Teva, Trevi Therapeutics, and UCB Biopharma; support for attending meetings from Sanofi Genzyme, LEO Pharma, Novartis, and UCB Biopharma; honoraria as an investigator from AbbVie, Aceleryn, Almirall Hermal, Amgen, AnaptysBio, Argenx, Aslan, Boehringer Ingelheim, Biocom, Bio Thera, Bristol Myers Squibb, Celtrion, CuraTeQ Biologics, DICE Therapeutics, Eli Lilly, Helm AG, Galapagos, Galderma, Janssen, Incyte, InflaRX, Kliniksa, Kymab Limited, LEO Pharma, Medimmune, Menlo Therapeutics, Merck, Moonlake, Novartis, Pierre Fabre, Pfizer, Regereron Pharmaceuticals, Takeda, Teva, Trevi Therapeutics, UCB Biopharm, Uni Therapeutics, and Ventyx Bioscence; and is President of the Polish Dermatological Society (unpaid). None of these parties or funders had any influence in any part of the preparation of this Seminar.

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