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Controversies in Hidradenitis Suppurativa: Bridging Gaps in Science and Practice

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: 25 October 2026 | Viewed by 684

Special Issue Editors


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Guest Editor
Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
Interests: dermatology; cutaneous surgery; wound healing; hidradenitis suppurativa (HS)

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Guest Editor
Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
Interests: dermatology; hidradenitis suppurativa; chronic itch; inflammatory skin disease

Special Issue Information

Dear Colleagues,

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disorder marked by painful nodules, abscesses, and sinus tract formation. Despite growing awareness and recent advances, significant controversy persists regarding its underlying mechanisms, optimal treatment strategies, and classification as either a primarily infectious, inflammatory, genetic, or immune-driven disease.

This Special Issue aims to spotlight the most pressing and debated aspects of HS through point–counterpoint style contributions from leading experts across disciplines. Topics will explore key controversies including the following:

  • Infection vs. Inflammation: Revisiting the microbiome’s vs. immune cell role in HS pathogenesis;
  • Genetic vs. Sporadic Origins: Unpacking heritability and disease onset;
  • Medical vs. Surgical Management: Defining the standard of care in complex HS;
  • Innate vs. Adaptive Immunity: Interrogating immune dysregulation and therapeutic targets.

By fostering scientific dialogue across divergent viewpoints, this Special Issue seeks to stimulate research collaboration, inform clinical decision making, and guide the development of consensus in HS care.

Dr. Hadar Lev-Tov
Dr. Tammy González
Guest Editors

Manuscript Submission Information

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Keywords

  • hidradenitis suppurativa (HS)
  • inflammatory skin disorder
  • controversies
  • treatment strategies
  • science and practice

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Published Papers (1 paper)

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Review

20 pages, 1350 KB  
Review
A Neuroendocrine–Immune Model of Hidradenitis Suppurativa: Mechanistic Insights into Pain, Pruritus, and Hormonal Triggers
by Sophie M. Bilik, Rebecca E. Kaiser, Jacob Jalal Shawwa, Benjamin Fleischmann, Sierra Simecek, Irena Pastar and Rivka C. Stone
J. Clin. Med. 2026, 15(10), 3820; https://doi.org/10.3390/jcm15103820 - 15 May 2026
Viewed by 317
Abstract
Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease traditionally viewed through a purely dermatologic lens. However, this perspective fails to explain stress-induced flares, menstrual cycle-linked exacerbations, and severe pain and itch disproportionate to visible cutaneous inflammation. This narrative review synthesizes evidence [...] Read more.
Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease traditionally viewed through a purely dermatologic lens. However, this perspective fails to explain stress-induced flares, menstrual cycle-linked exacerbations, and severe pain and itch disproportionate to visible cutaneous inflammation. This narrative review synthesizes evidence supporting a neuroendocrine–immune model of HS pathogenesis, with emphasis on mechanisms underlying pain and itch. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases (January 1990–September 2025) with terms including hidradenitis suppurativa, neuroendocrine mechanisms, HPA axis, sex hormones, neuropeptides, pain (including nociceptive and neuropathic pain, burning, and dysesthesia), and pruritus (itch). Eligible studies included peer-reviewed research examining hormonal, stress-related, or neuropeptide mechanisms in HS. Data were synthesized into thematic categories: endocrine influences, HPA axis function, neuropeptide signaling, immune crosstalk, and clinical implications. Results: Sex hormones promote follicular occlusion and modulate immune responses, explaining perimenstrual flares. Prolactin amplifies inflammation during stress through immune cell activation. Insulin resistance and adipokine imbalance create pro-inflammatory conditions. Chronic stress induces HPA axis dysfunction with cortisol resistance, exacerbating inflammation. Neuropeptides released from cutaneous nerves amplify immune activation and directly mediate pain and itch. These pathways establish self-perpetuating feedback loops wherein inflammation drives stress, and neuroendocrine dysfunction amplifies immune responses. Conclusions: HS represents a systemic disorder with a strong neuroendocrine–immune component, rather than a purely dermatologic condition. This framework supports multidisciplinary management integrating hormonal therapies, targeted immunomodulation, and stress reduction. Future research should characterize neuroendocrine biomarkers and test combination therapies targeting multiple system nodes. Full article
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