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It has become increasingly clear that these barrier layers become compromised in skin diseases, especially in disorders of an (auto)inflammatory nature. In the case of hidradenitis suppurativa, great strides have been made in recent years in characterizing the underlying breakdown in homeostatic innate immunity, including an increasing understanding of the central role of the hair follicle in this process. This breakdown appears to occur at multiple levels: the pilosebaceous unit, associated epithelium, the cutaneous microbiome, alteration of immune cell function and local molecular events such as complement activation. This review seeks to summarize, contextualize and analyse critically our current understanding of how these innate immune barriers become dysregulated in the early stage(s) of hidradenitis suppurativa, and to speculate on where potential hidradenitis suppurativa research could be most fruitful.<\/jats:p>","DOI":"10.1111\/exd.14451","type":"journal-article","created":{"date-parts":[[2021,8,21]],"date-time":"2021-08-21T20:44:48Z","timestamp":1629578688000},"page":"1554-1568","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction?"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1737-0046","authenticated-orcid":false,"given":"Daniel G.W.","family":"Johnston","sequence":"first","affiliation":[{"name":"The Charles Institute of Dermatology School of Medicine University College Dublin Dublin 4 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