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This dysbiotic community may contribute to disease initiation or exacerbation through the induction of aberrant immune responses in the absence of infection. Hidradenitis suppurativa (HS) is a complex, multifaceted disease involving the skin, innate and adaptive immunity, microbiota and environmental stimuli. Herein, we discuss the current state of HS skin microbiome research and how microbiome components may activate pattern recognition receptor (PRR) pathways, metabolite sensing pathways and antigenic receptors to drive antimicrobial peptide, cytokine, miRNA and adaptive immune cell responses in HS. We highlight the major open questions that remain to be addressed and how antibiotic therapies for HS likely influence both microbial burden and inflammation. Ultimately, we hypothesize that the two\u2010way communication between the skin microbiome and host immune response in HS skin generates a chronic positive feed\u2010forward loop that perpetuates chronic inflammation, tissue destruction and disease exacerbation.<\/jats:p>","DOI":"10.1111\/exd.14398","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T05:11:50Z","timestamp":1621573910000},"page":"1453-1470","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Yin and Yang: A disrupted skin microbiome and an aberrant host immune response in hidradenitis suppurativa"],"prefix":"10.1111","volume":"30","author":[{"given":"Stephanie L.","family":"Schell","sequence":"first","affiliation":[{"name":"Department of Dermatology Penn State Health Hershey Medical Center Hershey PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea 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