Intrinsic Factors in the Pathogenesis of Hidradenitis Suppurativa: Genetics, Hormones, and the Microbiome

This review examines the complex pathogenesis of hidradenitis suppurativa (HS), focusing on genetic, hormonal, and microbiome factors. It identifies genetic links to hair follicle stem cell fate and androgen signaling, with inflammation influenced by the cutaneous and gut microbiomes. Hormonal factors, particularly during puberty and pregnancy, and metabolic factors like obesity and insulin resistance, are highlighted as contributors to HS. The review notes the altered microbiome in HS patients and suggests that a combination of therapies targeting hormonal, metabolic, and immunological factors may improve clinical outcomes. However, it emphasizes the need for further research to address unresolved questions about disease predisposition and progression.