Hidradenitis Suppurativa: Part of a Tetrad of Follicular Occlusion Disorders

Follicular occlusion disorders (FOD) represent a tetrad of chronic, recurrent inflammatory conditions united by a common pathophysiologic mechanism: follicular hyperkeratosis leading to occlusion, rupture, and subsequent abscess or sinus tract formation. First conceptualized as a triad in the 1950s and later expanded to a tetrad in the 1970s, this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS). Despite their shared pathogenesis, each condition carries distinct clinical features, epidemiological profiles, and management considerations. This article aims to provide a comprehensive review of FOD, with a primary emphasis on HS (the most prevalent of the disorders). Hidradenitis suppurativa is a debilitating disease affecting ∼1% of the global population, predominantly in females, and the diagnosis is often delayed by 7 or more years. Multiple genes are linked to FOD patients with a positive familial history in 35% to 40%, along with lifestyle factors (smoking, alcohol consumption, and obesity). Key inflammatory mediators, including TNF-α, IL-1β, and IL-17, drive the chronic tissue destruction characteristic of FOD, frequently resulting in scarring, lymphedema, and significant psychosocial impairment. Wound care is critical and often underemphasized in disease management. This article outlines evidence-informed wound care strategies for both nonsurgical and postsurgical presentations, including dressing selection, exudate and odor management, pain and itch control, infection management, and the emerging role of intravenous ertapenem as rescue therapy. An interprofessional approach, integrating dermatology, surgery, wound care nursing, and psychosocial support, is emphasized throughout as essential to improving patient outcomes and quality of life. GENERAL PURPOSE: To increase clinicians' understanding of follicular occlusion disorders including the associated risk factors, clinical manifestations, and evidence-based approaches for management. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: Assess clinical characteristics of each follicular occlusion disorderEvaluate the basic disease mechanisms for follicular occlusion disordersDescribe principal disease burdens that require wound care attentionIdentify the unique wound care strategies and follicular occlusion disorder challenges JOURNAL/aswca/04.03/00129334-202610000-00004/figure1/v/2026-09-18T181327Z/r/image-jpeg.