{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:02:09Z","timestamp":1790323329284,"version":"4.1.0"},"reference-count":108,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"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 a chronic, recurrent inflammatory skin disease characterized by painful nodules, abscesses, draining tunnels and scarring, with substantial effects on quality of life. Although the therapeutic landscape has expanded with biologics targeting TNF, IL\u201017A and IL\u201017A\/F, many patients do not achieve sustained disease control, and chronic, draining tunnels remain difficult to treat. Recent data support a more integrated view of HS as a heterogeneous, stage\u2010dependent disease in which inherited susceptibility, modifiable risk factors, epithelial dysfunction, immune activation and microbial ecology converge. In this review, we summarize clinically relevant advances in HS epidemiology, genetics, immunopathogenesis and microbiome research. Global studies highlight substantial variation in prevalence, sex distribution and clinical phenotype across populations, suggesting differences in risk architecture and disease expression. Genetic studies have moved the field beyond rare \u03b3\u2010secretase\u2010associated familial disease towards a polygenic model involving follicular and epithelial regulatory programmes, antigen presentation and immune regulation. Single cell and spatial studies further indicate that HS pathogenesis evolves from epithelial stress and perifollicular inflammation in HS\u2010prone skin, through IL\u20101\u2010, TNF\u2010, neutrophil\u2010 and IL\u201017\u2010associated acute inflammation, towards chronic immune\u2013stromal niches characterized by epithelialized tunnels, B cells, plasma cells, tertiary lymphoid structures, NETosis and fibrosis. In parallel, microbiome studies suggest that dysbiosis, particularly anaerobe\u2010rich and biofilm\u2010like communities within tunnels, acts primarily as an amplifier of chronicity rather than as a proven initiating event. Together, these findings support a shift from single\u2010pathway models towards stage\u2010specific and patient\u2010stratified approaches aimed at earlier diagnosis, rational treatment selection and prevention of irreversible tissue damage.<\/jats:p>","DOI":"10.1111\/jdv.70765","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:25:20Z","timestamp":1790321120000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pathogenesis of hidradenitis suppurativa: From susceptibility to chronicity"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-3814","authenticated-orcid":false,"given":"Kelsey R.","family":"van Straalen","sequence":"first","affiliation":[{"name":"Department of Dermatology Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha S.","family":"Chandran","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine National University Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"School of Biochemistry and Immunology and School of Medicine Trinity Biomedical Sciences Institute, Trinity College Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-3911","authenticated-orcid":false,"given":"Evangelos J.","family":"Giamarellos\u2010Bourboulis","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Medical School National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4227-7847","authenticated-orcid":false,"given":"Elia","family":"Rosi","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor B. E.","family":"Jemec","sequence":"additional","affiliation":[{"name":"PHOENIX Center, Department of Allergy, Dermatology and Venereology Herlev\u2010Gentofte Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)02475\u20109"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI186744"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.2373"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2021.01.023"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljaf277"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2024.11.010"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI169225"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.17892"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.15940"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0190\u20109622(96)90321\u20107"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.20954"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.19210"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.15071"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.17933"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.14340"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2017.0201"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.02.005"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.4700"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/12034754251404461"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljad317"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.20581"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.det.2024.12.002"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1159\/000491547"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2020.5467"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.13090"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15939"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.16117"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2024.2613"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2007.02.007"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586\u2010023\u201006968\u20108"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2023.122730"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70035"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.14433"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.5010"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102133.2009.09198.x"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.13732"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.19649"},{"key":"e_1_2_15_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2024.03.014"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555\u20101800"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584\u2010025\u201001326\u20106"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.det.2015.08.011"},{"key":"e_1_2_15_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15904"},{"key":"e_1_2_15_44_1","doi-asserted-by":"publisher","DOI":"10.1177\/1203475419874412"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257\u2010023\u201000756\u2010w"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajd.13110"},{"key":"e_1_2_15_47_1","doi-asserted-by":"publisher","DOI":"10.1159\/000517283"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2016.07.024"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/JW9.0000000000000135"},{"key":"e_1_2_15_50_1","doi-asserted-by":"publisher","DOI":"10.1177\/12034754251347592"},{"key":"e_1_2_15_51_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2020.3630"},{"key":"e_1_2_15_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.20654"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.1159\/000512455"},{"key":"e_1_2_15_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2024.09.001"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12048"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2023.2217"},{"key":"e_1_2_15_57_1","doi-asserted-by":"publisher","DOI":"10.1159\/000550386"},{"key":"e_1_2_15_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2005.06.064"},{"key":"e_1_2_15_59_1","doi-asserted-by":"publisher","DOI":"10.1242\/jcs.03070"},{"key":"e_1_2_15_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2024.11.050"},{"key":"e_1_2_15_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.70390"},{"key":"e_1_2_15_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2025.12.025"},{"key":"e_1_2_15_63_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljae399"},{"key":"e_1_2_15_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2022.02.003"},{"key":"e_1_2_15_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2016.04.036"},{"key":"e_1_2_15_66_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI131180"},{"key":"e_1_2_15_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2026.03.016"},{"key":"e_1_2_15_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2018.11.018"},{"key":"e_1_2_15_69_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.139930"},{"key":"e_1_2_15_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.16019"},{"key":"e_1_2_15_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.70269"},{"key":"e_1_2_15_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.19795"},{"key":"e_1_2_15_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2020.04.011"},{"key":"e_1_2_15_74_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15424"},{"key":"e_1_2_15_75_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.16428"},{"key":"e_1_2_15_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2017.05.033"},{"key":"e_1_2_15_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2023.05.012"},{"key":"e_1_2_15_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(23)00022\u20103"},{"key":"e_1_2_15_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)00101\u20106"},{"key":"e_1_2_15_80_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.19252"},{"key":"e_1_2_15_81_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13555\u2010023\u201000913\u20103"},{"key":"e_1_2_15_82_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljad274"},{"key":"e_1_2_15_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2026.01.041"},{"key":"e_1_2_15_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2022.10.034"},{"key":"e_1_2_15_85_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.14273"},{"key":"e_1_2_15_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.12.651"},{"key":"e_1_2_15_87_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aav5908"},{"key":"e_1_2_15_88_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.169870"},{"key":"e_1_2_15_89_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010026\u201070883\u20105"},{"key":"e_1_2_15_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2021.07.187"},{"key":"e_1_2_15_91_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.13978"},{"key":"e_1_2_15_92_1","doi-asserted-by":"publisher","DOI":"10.25251\/rhw51f12"},{"key":"e_1_2_15_93_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.14141"},{"key":"e_1_2_15_94_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2017.0904"},{"key":"e_1_2_15_95_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2019.08.445"},{"key":"e_1_2_15_96_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2019.06.151"},{"key":"e_1_2_15_97_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2012.140064"},{"key":"e_1_2_15_98_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix285"},{"key":"e_1_2_15_99_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2020.02.046"},{"key":"e_1_2_15_100_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555\u20102503"},{"key":"e_1_2_15_101_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.15597"},{"key":"e_1_2_15_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2023.08.017"},{"key":"e_1_2_15_103_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.14036"},{"key":"e_1_2_15_104_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljad184"},{"key":"e_1_2_15_105_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.140598"},{"key":"e_1_2_15_106_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.15087"},{"key":"e_1_2_15_107_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2025.06.008"},{"key":"e_1_2_15_108_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjidi.2026.100461"},{"key":"e_1_2_15_109_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.19725"}],"container-title":["Journal of the European Academy of Dermatology and Venereology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdv.70765","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jdv.70765","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdv.70765","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:25:21Z","timestamp":1790321121000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jdv.70765"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":108,"alternative-id":["10.1111\/jdv.70765"],"URL":"https:\/\/doi.org\/10.1111\/jdv.70765","archive":["Portico"],"relation":{},"ISSN":["0926-9959","1468-3083"],"issn-type":[{"value":"0926-9959","type":"print"},{"value":"1468-3083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"assertion":[{"value":"2026-06-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jdv.70765"}}