{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T18:03:27Z","timestamp":1789322607864,"version":"build-2803163510"},"reference-count":89,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hidradenitis suppurativa (HS) is increasingly recognized as a progressive inflammatory disease in which recurrent follicular inflammation, tunnel formation and systemic inflammation drive cumulative, largely irreversible tissue damage, quality\u2010of\u2010life impairment and cardiometabolic comorbidity. Despite this, no consensus definition of disease progression exists. This review synthesizes current evidence to propose a working, multidimensional framework for progression in HS and to map its determinants, detection tools and consequences. We frame progression along six complementary dimensions grouped in three blocks\u2014objective severity (Hurley transition, International Hidradenitis Suppurativa Severity Score System [IHS4] category shift), anatomical extension (extra\u2010 and intraregional spread) and cumulative disease burden (secondary complications and patient\u2010reported impact)\u2014aligned with current European guidelines for therapeutic escalation. Available longitudinal data show that incidence and speed of progression depend strongly on care setting and assessment method, with tertiary cohorts assessed clinically and by ultrasound reporting incidences of approximately 37% over ~2\u2009years and self\u2010reported community cohorts substantially lower. Independent risk factors cluster into demographic\u2010familial, phenotypic\u2010anatomical, lifestyle\u2010metabolic, laboratory and comorbidity domains, with early\u2010onset disease, smoking, inflammatory bowel disease, Down syndrome and pilonidal sinus as the most consistent signals. Phenotype frameworks converge on a higher\u2010risk profile of male, smoker patients with severe acne and lower\u2010body involvement. Genotype shapes phenotype, with \u03b3\u2010secretase\/Notch variants driving an occlusion\u2010dominant course and inflammasome variants (PASH, PAPASH, PAPA, SAPHO) a more systemic one; heritability approaches 77%. Ultrasound refines staging, detects subclinical microtunnels and identifies the inflamed non\u2010draining tunnel that defines a within\u2010lesion window of opportunity. Progression has tangible cutaneous, psychosocial, systemic, metabolic and cardiovascular consequences, making early recognition a clinical imperative; disease modification within a limited therapeutic window remains a plausible and testable paradigm rather than a demonstrated fact.<\/jats:p>","DOI":"10.1111\/jdv.70717","type":"journal-article","created":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T17:16:47Z","timestamp":1789319807000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disease progression in hidradenitis suppurativa: A multidimensional framework"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-2113","authenticated-orcid":false,"given":"Alejandro","family":"Molina\u2010Leyva","sequence":"first","affiliation":[{"name":"Dermatology Department Hospital Universitario Virgen de las Nieves  Granada Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria ibs.GRANADA  Granada Spain"},{"name":"Department of Dermatology School of Medicine, University of Granada  Granada Spain"},{"name":"European Hidradenitis Suppurativa Foundation (EHSF)  Dessau\u2010Ro\u00dflau Germany"},{"name":"Hidradenitis Suppurativa Group Spanish Academy of Dermatology and Venereology (AEDV)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farida","family":"Benhadou","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation (EHSF)  Dessau\u2010Ro\u00dflau Germany"},{"name":"Department of Dermatology, H\u00f4pitaux Universitaires de Bruxelles Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif","family":"Sali","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Erasmus MC University Medical Center Rotterdam  Rotterdam the 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