Improving the patient care pathway and multidisciplinary management are major challenges in Hidradenitis suppurativa treatment

Hidradenitis suppurativa (HS) is a chronic inflammatory disease resulting from the close interplay between genetic predisposition, dysregulation of the mechanisms involved in autoinflammatory pathways, dysfunctional response to bacterial biofilm changes, and environmental factors that potentially exacerbate the disease. Its cutaneous manifestations may represent just the tip of the iceberg, as numerous comorbidities may be associated with the disease. The risk of occurrence of inflammatory bowel disease is three times higher than that in the general population. At least 5% of patients also have spondylarthritis, and the risk of cardiovascular events and death from myocardial infarction is significantly increased. Psychiatric co-morbidities, ranging from severe anxiety to depression and suicidal risk, also contribute greatly to the disease burden. The painful and chronic nature of the flares and the highly conspicuous appearance of HS lesions, whether inflammatory or permanent scarring, can lead to social isolation and addiction, particularly to analgesics. Despite its high frequency, easy diagnosis, severe impact on patients' daily lives, and the discovery of new treatments, many patients still experience prolonged diagnostic delays, therapeutic inertia, and chaotic, inappropriate management. For HS and the prevention of associated major complications, the identification of the points of rupture in its management, an improved care pathway and a multidisciplinary therapeutic approach are a societal concern and a major public health challenge.