The Skin and Gut Microbiome in Hidradenitis Suppurativa

Recent evidence indicates that both the bacterial composition of the skin and gut microbiota may contribute to the pathogenesis and progression of hidradenitis suppurativa (HS). Several studies have identified alterations in the skin bacterial microbiota, including an increased abundance of anaerobic taxa such as Prevotella spp. and Porphyromonas spp., alongside a reduction in commensal species like Cutibacterium spp., changes that may promote chronic inflammation and biofilm formation. Comparative analyses of lesional versus non-lesional skin have also revealed enrichment of bacterial pathways related to cell growth, DNA replication, and mismatch repair, suggesting enhanced microbial proliferation within HS lesions. Emerging evidence further suggests the presence of bacterial gut dysbiosis in HS, with some studies reporting reduced microbial diversity and lower abundance of protective genera Ruminococcaceae, and Lachnospiraceae families. Efforts to modulate the skin and gut microbiota in HS are underway, exploring approaches such as dietary modification, antibiotic usage, and probiotic supplementation. Moreover, comorbid conditions frequently associated with HS appear to influence disease severity and may mediate the relationship between microbial imbalance and systemic inflammation. Despite these insights, current research remains fragmented, characterized by small sample sizes, heterogeneous study designs, and a scarcity of robust interventional data.