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Introduction

Hidradenitis suppurativa (HS) is a chronic skin condition characterized by recurrent inflammatory nodules and abscesses that leads to sinus tract formation and scarring.  It primarily affects folliculopilosebaceous units in intertriginous areas (eg, axillae, groin, perianal region).  HS can significantly impact a patient's quality of life due to its physical, emotional, and social consequences.

Pathophysiology

HS begins with the occlusion of folliculopilosebaceous units* caused by keratinocyte hyperproliferation and abnormal keratinocyte differentiation ( Figure 1).  Mechanical stress (eg, friction in intertriginous areas) then leads to follicular rupture and the release of proinflammatory contents.  Exacerbated by immune dysregulation and subsequent bacterial colonization or infection, the initial inflammation evolves into a chronic inflammatory response that progresses to abscesses, sinus tracts (formed by epithelial stem cells released from follicular rupture), comedones (from follicular destruction), and extensive fibrosis.

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