Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment

Maddalena Napolitano,¹ Matteo Megna,² Elena A Timoshchuk,³ Cataldo Patruno,² Nicola Balato,² Gabriella Fabbrocini,² Giuseppe Monfrecola<sup>2

1</sup>Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, ²Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; ³Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia

Abstract: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting 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 environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture, and immune responses (perifollicular lympho-histiocytic inflammation), finally leading to the development of clinical HS lesions. HS has a destructive impact on the patient’s quality of life, being a very challenging disease. Available treatments are limited, mostly off-label and with high variability in the reported efficacy. Fortunately, a monoclonal antibody against tumor necrosis factor alpha has been recently approved for treatment of moderate to severe HS, offering patients a promising new option. This review focuses on the main features of HS, including epidemiology, clinical aspects, pathogenesis, severity classifications, comorbidities, and currently available treatments.

Keywords: hidradenitis suppurativa, pathogenesis, diagnosis, treatment