The pathogenesis of hidradenitis suppurativa: Evolving paradigms in a complex disease

Abstract Hidradenitis suppurativa is a complex inflammatory skin disease with the molecular pathogenesis of disease incompletely understood. Recent observational and experimental insights into disease pathogenesis are challenging long‐held beliefs regarding the causes and mechanisms of disease. The most effective treatments to date are anti‐inflammatory in nature suggesting inflammation is the major driver of disease activity. This study critically evaluates the existing literature regarding the mechanisms of disease pathogenesis. Specifically, it questions the role of follicular occlusion as the central driver of disease activity and reframes hidradenitis suppurativa as a complex autoinflammatory and autoimmune disorder. Ongoing efforts to understand the mechanisms of disease will no doubt lead to more efficacious therapeutics to control this burdensome disabling disease.