Hidradenitis suppurativa: Detangling phenotypes and identifying common denominators

Area of Science:

• Dermatology
• Immunology
• Genetics

Background:

• Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease impacting quality of life.
• Current understanding of HS pathophysiology is limited, hindering effective treatment.
• HS presents with significant clinical heterogeneity, complicating diagnosis and management.

Purpose of the Study:

• To highlight the challenges in understanding HS due to gaps in pathogenic mechanisms.
• To emphasize the need for improved classification and phenotyping for prognostication and management.
• To underscore the importance of genotype-endotype-phenotype correlations in HS research.

Main Methods:

• Review of current understanding of HS pathophysiology.
• Analysis of diagnostic and classification challenges.
• Discussion of multifactorial hypotheses including genetics, microbiome, and environment.

Main Results:

• Significant gaps exist in pinpointing HS underlying mechanisms, explaining clinical variation.
• Current HS classification systems lack validation and show overlap.
• Nomenclature for HS lesions lacks global agreement, impeding severity scoring.

Conclusions:

• Valid, predictive HS classifications are needed to improve pathophysiology comprehension and personalize management.
• Consensus on clinical features and data gathering is essential for phenotype validation.
• Further research into genotype-endotype-phenotype correlations is required for a broader perspective on HS.