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While infectious organisms have been identified in lesions of the disease since the 1980s, questions remain over the role that bacteria and microbiome play. Recent studies using 16S ribosomal RNA gene sequencing and larger culture\u2010based studies have begun to paint a clearer picture of the microbial world of HS. With this systematic review, we summarize all the work that has been done to date in HS bacteriology, analyse potential pitfalls and limitations of the current studies, and address future directions of investigation. This systematic review attempted to collate and analyse all bacteriology studies done to date. This review was prospectively registered with PROSPERO (1670769) performed in line with the PRISMA checklist. Twenty two studies were identified comprising 862 individual HS patients for culture studies and 206 HS patients for 16S rRNA gene sequencing studies. Methodology tended to be varied, with different sampling, culturing and sequencing methods as well as amount of analysis and stratification of patients. Bacteria identified as elevated in HS lesions in sequencing studies as well as grown from HS lesions in culture studies are identified and discussed. These primarily included the anerobic Gram\u2010negative bacilli <jats:italic>Prevotella<\/jats:italic>, <jats:italic>Porphyromonas<\/jats:italic> and <jats:italic>Fusibacterium<\/jats:italic>, the Gram\u2010positive bacilli <jats:italic>Corynebacterium<\/jats:italic>, and the Gram\u2010positive cocci <jats:italic>Staphylococcus<\/jats:italic>, <jats:italic>Streptococcus<\/jats:italic> and <jats:italic>Parvimonas.<\/jats:italic> Potential interactions, as well as work in other disease models with related bacteria are also discussed. Areas of further investigation include in vitro studies of interactions between bacteria and keratinocytes, gut and oral microbiome studies and deep sequencing studies for virulence and phage factors.<\/jats:p>","DOI":"10.1111\/exd.14141","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T20:39:33Z","timestamp":1593722373000},"page":"1388-1397","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["A systematic review and critical appraisal of metagenomic and culture studies in hidradenitis suppurativa"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1916-1579","authenticated-orcid":false,"given":"Samuel C.","family":"Williams","sequence":"first","affiliation":[{"name":"Laboratory of Investigative Dermatology Rockefeller University New York New York"},{"name":"Weill Cornell\/Rockefeller\/Sloan Kettering Tri\u2010Institutional MD\u2010PhD Program 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