Immune dysregulation is strongly implicated in the pathogenesis of hidradenitis suppurativa (HS) (Vossen et al., 2018). This is demonstrated by the presence of inflammation in both lesional and perilesional HS skin (Kelly et al., 2015; Van der Zee et al., 2012; Witte-Händel et al., 2019). However, our current understanding of HS pathophysiology, with follicular occlusion and rupture as the primary events, is under scrutiny. A complex immune-driven pathogenesis, initiated by an initial aberrant immune response to a possibly dysbiotic cutaneous microbiome, is suspected, with follicular occlusion occurring as a secondary phenomenon (Frew, 2019).
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Vossen et al. (2020) studied this question.
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