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Cases of HS were identified by the International Classification of Diseases (ICD)-8 (705\u00b791) and ICD-10 (L73\u00b72). Heritability was assessed by the classic biometric model and the possibility of gene\u2013gene interaction via the multilocus modelling approach.<\/jats:p>\n                  <jats:p>Results<\/jats:p>\n                  <jats:p>Among 100 044 registered twins, we found 170 twins (from 163 pairs) diagnosed with HS. The seven concordant pairs were all monozygotic. Monozygotic twins had a case-wise concordance rate of 28% [95% confidence interval (CI) 7\u201349], corresponding to a familial risk of 73 (95% CI 13\u2013133) times that of the background population. The biometrical modelling suggested a heritability of 0\u00b780 (95% CI 0\u00b767\u20130\u00b793), and the multilocus index estimate was 230 (95% CI 60\u2013400). This is highly indicative of gene\u2013gene interactions, with the possibility of up to six interacting loci.<\/jats:p>\n                  <jats:p>Conclusions<\/jats:p>\n                  <jats:p>This twin study was substantially larger and employed a more valid phenotype than previous studies. Genetics account for the majority of HS susceptibility, and HS is most likely caused by gene\u2013gene interactions rather than monogenetic mutations or solely additive genetic factors. New approaches aimed at assessing potential interactions at a single-nucleotide polymorphism (SNP)\u2013SNP level should be implemented in future HS genome-wide association studies.<\/jats:p>","DOI":"10.1111\/bjd.20654","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T13:10:14Z","timestamp":1626873014000},"page":"78-85","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Evidence of gene\u2013gene interaction in hidradenitis suppurativa: a nationwide registry study of Danish twins"],"prefix":"10.1093","volume":"186","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0159-670X","authenticated-orcid":false,"given":"R.","family":"Kj\u00e6rsgaard Andersen","sequence":"first","affiliation":[{"name":"Department of Dermatology Zealand University Hospital Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9871-149X","authenticated-orcid":false,"given":"S.B.","family":"Clemmensen","sequence":"additional","affiliation":[{"name":"Danish Twin Registry Department of Epidemiology, Biostatistics and Biodemography University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0426-0569","authenticated-orcid":false,"given":"L.A.","family":"Larsen","sequence":"additional","affiliation":[{"name":"Danish Twin Registry Department of Epidemiology, Biostatistics and Biodemography University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9630-9149","authenticated-orcid":false,"given":"J.v.B.","family":"Hjelmborg","sequence":"additional","affiliation":[{"name":"Danish Twin Registry Department of Epidemiology, Biostatistics and Biodemography University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3135-5624","authenticated-orcid":false,"given":"N.","family":"\u00d8dum","sequence":"additional","affiliation":[{"name":"LEO Foundation Skin Immunology Research Center Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0712-2540","authenticated-orcid":false,"given":"G.B.E.","family":"Jemec","sequence":"additional","affiliation":[{"name":"Department of Dermatology Zealand University Hospital Roskilde Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5429-5292","authenticated-orcid":false,"given":"K.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Danish Twin Registry Department of Epidemiology, Biostatistics and Biodemography University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,1]]},"reference":[{"key":"2023010800163106600_bjd20654-bib-0001","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1056\/NEJMcp1014163","article-title":"Clinical practice. 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