Hidradenitis suppurativa: state-of-the-art review and update

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels in areas such as the axillae, groin, and inframammary regions. It typically emerges in early adulthood, with a global prevalence of approximately 1%, though regional variations exist. HS significantly affects patients' quality of life and imposes considerable socioeconomic burdens. It is frequently associated with metabolic syndrome, inflammatory arthritis, and inflammatory bowel disease, reflecting its underlying systemic inflammatory nature. The pathogenesis of HS involves innate immune mechanisms, including macrophages, neutrophils, interleukin (IL)-1β, tumor necrosis factor-alpha (TNF-α), and granulocyte colony-stimulating factor, alongside adaptive immune responses mediated by T cells (IL-17, interferon-gamma [IFN-γ]) and B cells, which contribute to autoantibody formation and tertiary lymphoid structures. Chronic inflammation results in irreversible tissue damage, tunnel formation, and severe scarring. Treatment strategies vary based on disease severity. Early inflammatory stages benefit from pharmacological therapies, while later stages require a combination of medical and surgical interventions, with surgery often necessary for advanced cases. The introduction of targeted biologic therapies, including TNF-α (adalimumab) and IL-17 inhibitors (secukinumab, bimekizumab), has expanded treatment options beyond traditional antibiotic regimens. Effective management focuses on early intervention to prevent irreversible damage, control symptoms such as pain, and address systemic comorbidities. A timely diagnosis, along with a multidisciplinary and personalized approach, is essential for improving patient outcomes and quality of life.