Hidradenitis suppurativa pathogenesis: Extrinsic factors

While genetic predisposition and immune dysregulation are recognized as key contributors to the development of hidradenitis suppurativa, accumulating research points to the influence of extrinsic factors in the pathogenesis of this condition. This review explores the roles of mechanical stress, altered skin and gut microbiome, tobacco smoking, diet, and paradoxical drug reactions as drivers of hidradenitis suppurativa onset and progression. A holistic management approach addressing these factors may be encouraged to improve disease outcomes. Further research is needed to fully determine the causal role of these extrinsic factors and their impact on treatment strategies. ( J Am Acad Dermatol 2024;91:S17-21.)