A Comprehensive Review of Hidradenitis Suppurativa: From Pathogenesis to Clinical Insights & Novel Therapeutic Advancements

Hidradenitis suppurativa is a chronic, inflammatory, recurrent, and debilitating follicular skin disease that profoundly impacts patients' quality of life. Recent evidence suggests that follicular occlusion is the primary initiating event. Pain is a significant complication of this disease, experienced as either acute nociceptive pain during flare-ups or chronic pain, both of which negatively affect patients' quality of life. This narrative review utilized the Scale for the Assessment of Narrative Review Articles (SANRA) to ensure the methodological quality and comprehensiveness of the search strategy and criteria. It is clinically diagnosed using three main criteria: typical lesions, classical locations in intertriginous areas, and two or more occurrences within six months. Most studies indicate a diagnostic delay of 6 to 10 years after initial presentation, averaging ten years. This delay can lead to worse patient morbidity, higher healthcare costs, and increased likelihood of wage loss due to work absence. The most common tools used to assess the severity of this condition are the Hurley staging system, Sartorius scoring, and HS Physician Global Assessment systems. Medical treatments include antibiotics, retinoids, hormonal agents, intralesional corticosteroid and botulinum toxin injections, laser hair removal, photodynamic therapy, and biologics. In conclusion, inadequate recognition of the disease hinders its diagnosis and early treatment. This review aims to disseminate knowledge about the disease, its variable clinical presentation, and possible therapies within the medical community.