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Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management
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Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management

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

Deadline for manuscript submissions: 25 August 2026 | Viewed by 2824

Editor

Dr. Piotr K. Krajewski

E-Mail Website
Guest Editor
1. Division of Dermatology, Venereology and Clinical Immunology, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
2. Department of Dermatovenereology, 4th Military Hospital, Wroclaw, Poland
Interests: hidradenitis suppurativa; acne inversa; dermatology

Special Issue Information

Dear Colleagues,

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin condition marked by painful nodules, abscesses, draining tunnels, and scarring in intertriginous areas. It significantly affects quality of life and psychosocial well-being. Despite growing awareness, HS is often underdiagnosed, frequently mismanaged, and shares a high prevalence of systemic comorbidities such as metabolic, cardiovascular, rheumatologic, and psychiatric disorders.

This Special Issue, “Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management”, aims to deliver a current, clinically focused overview of HS—from early detection and differential diagnosis to validated severity assessments and multidisciplinary long-term management. We invite original research and reviews that explore diagnostic challenges, disease heterogeneity, biomarkers, imaging, and patient-reported outcomes. Special focus should be on innovative medical and surgical treatments, optimizing biologic therapies, managing refractory disease, care transitions, and real-world data on effectiveness and safety across various patient groups.

Dr. Piotr K. Krajewski
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hidradenitis suppurativa
  • acne inversa
  • clinical diagnosis
  • disease severity assessment
  • biologic therapy
  • surgical management
  • comorbidities
  • quality of life
  • multidisciplinary care
  • real world evidence

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Published Papers (4 papers)

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Research

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15 pages, 1133 KB  
Article
Psychiatric Comorbidity in Hidradenitis Suppurativa—A Large-Scale Retrospective Cohort Study
by Beata Jastrząb-Miśkiewicz, Jacek C. Szepietowski and Piotr K. Krajewski
J. Clin. Med. 2026, 15(13), 4982; https://doi.org/10.3390/jcm15134982 - 26 Jun 2026
Viewed by 175
Abstract
Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with psychiatric burden, but longitudinal data on incident psychiatric outcomes remain limited. This study aimed to evaluate incident psychiatric disorders in adults with HS compared with matched non-HS controls and to [...] Read more.
Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with psychiatric burden, but longitudinal data on incident psychiatric outcomes remain limited. This study aimed to evaluate incident psychiatric disorders in adults with HS compared with matched non-HS controls and to assess sex-specific risk. Methods: We conducted a retrospective propensity score–matched cohort study using the TriNetX Global Collaborative Network. Adults with at least two HS diagnoses and no prior psychiatric diagnosis were compared with non-HS controls with repeated general health examination encounters and no psychiatric history. Time-to-event analyses estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Sensitivity analyses used a 30-day lag and restriction to the most recent 5-year period. Results: After matching, 37,964 pairs were retained for the primary individual-outcome analysis. Median follow-up was shorter in the HS cohort than in matched controls (844 vs. 1505 days). HS was associated with increased risk of any psychiatric disorder (12.3% vs. 5.8%; HR 3.17, 95% CI 3.01–3.34) and severe psychiatric illness (0.6% vs. 0.1%; HR 6.70, 95% CI 4.77–9.41). Elevated risks were observed for bipolar/manic disorders, personality disorders, substance use disorders, psychotic disorders, suicidal ideation, depression, eating disorders, anxiety, and insomnia/parasomnia. Women had higher hazards of depression and anxiety, whereas men had higher hazards of substance use disorders; insomnia/parasomnia showed a nominal association with higher hazard in men. Conclusions: In this observational EHR-based study, HS was associated with broad incident psychiatric morbidity. These findings support consideration of proactive mental health assessment and integrated dermatologic–psychiatric care in patients with HS. Full article
(This article belongs to the Special Issue Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management)
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11 pages, 947 KB  
Systematic Review
Decoding Inflammation in Hidradenitis Suppurativa: Serum Cytokines as Biomarkers of Disease Severity and Treatment Outcome—Systematic Review
by Anna Tekielak, Karina Polak, Aleksandra Frątczak and Beata Bergler-Czop
J. Clin. Med. 2026, 15(12), 4699; https://doi.org/10.3390/jcm15124699 - 17 Jun 2026
Viewed by 221
Abstract
Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with systemic features, characterized by painful nodules, abscesses, and sinus tracts. Pro-inflammatory cytokines may serve as biomarkers of disease severity, inflammatory burden, and therapeutic response. The aim of this article is to [...] Read more.
Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with systemic features, characterized by painful nodules, abscesses, and sinus tracts. Pro-inflammatory cytokines may serve as biomarkers of disease severity, inflammatory burden, and therapeutic response. The aim of this article is to systematically review the current evidence on serum concentrations of pro-inflammatory cytokines in patients with HS and to evaluate their potential utility as biomarkers of disease activity and personalized treatment guidance. Materials and Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A literature search was performed in PubMed, Embase, and Scopus, with Google Scholar used as a supplementary source. The search included English-language publications from 2015 to 2026. The following keywords were used in combination: “cytokines”, “serum”, “hidradenitis suppurativa”, and “markers”. In addition, reference lists and citations of eligible full-text articles were manually screened. Eligible studies for inclusion were peer-reviewed, original human studies reporting serum cytokine levels in patients with HS. Reviews, meta-analyses, case reports, editorials, letters, in vitro and animal studies, conference abstracts without the full text available, non-serum studies, and thematically unrelated publications were excluded. Results: Database searches identified records in PubMed, Embase, Scopus, and Google Scholar, of which three PubMed studies met the inclusion criteria. Manual screening of reference lists and citations identified three additional eligible publications. Overall, six studies were included in the final qualitative synthesis. The included studies reported elevated serum levels of key inflammatory mediators, including IL-17A, IL-6, IL-1β, IL-23, IL-18, and soluble TNF receptors, in patients with HS compared to healthy controls. Several cytokines were associated with disease severity, and selected markers showed changes during biologic treatment. Stratification into immunological endotypes based on cytokine profiles and clinical features was also proposed. Conclusions: Pro-inflammatory cytokines, especially those involved in the IL-1β–IL-17 axis, show potential as biomarkers of disease severity and treatment response in HS. Their assessment may support future personalized therapeutic strategies. However, current evidence remains limited by small study numbers and methodological heterogeneity. Further large-scale prospective and longitudinal studies are required before serum cytokine profiling can be implemented in routine clinical practice. Full article
(This article belongs to the Special Issue Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management)
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17 pages, 382 KB  
Systematic Review
Revisiting Radiotherapy for Hidradenitis Suppurativa: Clinical Outcomes, Safety, and Optimization Strategies: A Systematic Review
by Michal Poltorak, Pawel Banatkiewicz, Lukasz Poltorak, Maciej Szwast and Irena Walecka
J. Clin. Med. 2026, 15(8), 3164; https://doi.org/10.3390/jcm15083164 - 21 Apr 2026
Viewed by 670
Abstract
Objectives: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that significantly impairs patients’ quality of life, especially in its moderate to severe forms. Traditional treatments, including antibiotics, hormonal therapies, and surgery, often fail to provide long-term relief in such cases. This [...] Read more.
Objectives: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that significantly impairs patients’ quality of life, especially in its moderate to severe forms. Traditional treatments, including antibiotics, hormonal therapies, and surgery, often fail to provide long-term relief in such cases. This study aims to explore the role of radiotherapy, particularly with the use of 3D printing technology to create personalized boluses and applicators, as an adjunctive treatment for refractory HS. A systematic review of published studies was conducted to assess the efficacy of radiotherapy in managing HS, with a specific focus on studies using 3D printing technology to create customized boluses and applicators. Methods: Publications from databases such as PubMed, Scopus, and Google Scholar were analyzed for studies detailing radiotherapy techniques, dosing regimens, and the use of 3D-printed devices in HS treatment. The studies selected included those employing both external beam radiotherapy and brachytherapy, with particular emphasis on patient outcomes and adverse effects. Results: The reviewed studies highlighted a growing body of evidence supporting the use of radiotherapy for HS, especially in severe or treatment-resistant cases. The use of 3D-printed boluses and applicators in radiotherapy demonstrated significant improvements in treatment precision and patient comfort. Personalized treatment plans allowed for more accurate dose distribution, minimized air gaps, and reduced exposure of healthy tissue. No major long-term toxicity was reported across the majority of studies. Conclusions: Radiotherapy, particularly when combined with 3D printing technology, presents a promising treatment option for patients with severe or refractory HS. Customizable boluses and applicators enhance the precision of radiotherapy by conforming to irregular skin surfaces, thereby improving dose conformity and reducing side effects. Despite the positive results, further research is needed to assess the long-term safety and clinical feasibility of this approach. The integration of 3D printing in radiotherapy could significantly improve treatment outcomes, offering a more personalized and effective therapeutic option for HS patients. Full article
(This article belongs to the Special Issue Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management)
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15 pages, 1008 KB  
Systematic Review
Effects of GLP-1 Agonists on Patients with Hidradenitis Suppurativa: A Systematic Review
by Annik Caliezi, Aref Hosseini, Ronald Wolf and Seyed Morteza Seyed Jafari
J. Clin. Med. 2026, 15(8), 2909; https://doi.org/10.3390/jcm15082909 - 11 Apr 2026
Viewed by 1338
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, which presents with painful nodules, abscesses and sinus tracts. Patients suffer from pain, drainage and worsening of mental health and quality of life. Treatment is often difficult. HS is typically associated with obesity [...] Read more.
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, which presents with painful nodules, abscesses and sinus tracts. Patients suffer from pain, drainage and worsening of mental health and quality of life. Treatment is often difficult. HS is typically associated with obesity and metabolic syndrome; thus, antidiabetics, especially GLP-1 agonists, present a potential therapy option. The aim of this review was to analyze the effects of GLP-1 agonists on patients with HS, including on their cardiovascular risk and quality of life. Methods: A literature search was conducted on Embase and PubMed, yielding 300 papers, of which 10 were used for this review. Results: HS patients using GLP-1 agonists showed improved clinical course with less pain and suppuration. Further, patients’ quality of life and mental health improved and their cardiovascular risk was reduced. Inflammatory parameters showed no significant changes. Patients receiving a higher drug dose of GLP-1 agonists were more likely to show clinical improvement. A reduction in weight or BMI did not correlate with improvements in Hurley stage, pain or depression. Hence, HS patients could be treated with GLP-1 agonists. Conclusions: Therefore, whether patients’ improvement is due to weight loss, or other mechanisms, i.e., GLP-1 agonists’ anti-inflammatory properties, remains to be determined in further studies. Full article
(This article belongs to the Special Issue Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management)
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