Hidradenitis suppurativa (HS) is a chronic multifaceted, potentially scarring, inflammatory skin disease affecting the pilosebaceous units (PSU) of the axilla, inframammary folds, groin and buttocks. Clinical features include painful inflammatory nodules, abscesses and draining sinus tracts that produce a purulent, foul-smelling discharge. The estimated prevalence of HS is 0.2-0.6% globally, but the prevalence varies by geographic location: 0.5-1.3% in Europe, 0.7-1.2% in the United States and 0.01%-2.2% in the Asia-Pacific region. 1,2 Common comorbidities and behaviours associated with HS include diabetes, pulmonary disease, metabolic syndrome, obesity, polycystic ovary syndrome, inflammatory bowel disease, smoking and mechanical stress on skin. 1,3-5 HS negatively impacts patients' quality of life and causes significant economic burden on patients and the healthcare system. [6][7][8][9][10] The pathogenesis of HS is not fully understood. However, evidence supports the hypothesis that hair follicle occlusion leads to follicle rupture and an aberrant immune response to follicular and bacterial debris, triggering a cycle of damage and chronic inflammation. 7,[11][12][13][14] Factors involved in HS pathogenesis include genetics, hormones, local environmental factors (eg sweating, skin friction), abnormal host responses to skin bacteria and impaired wound healing. [15][16][17][18] Approximately 30% of patients have a family history of HS, and of these, about 10% of these familial cases have an inactivating mutation in the γ-secretase enzyme complex. 19,20 These γ-secretase mutations are relatively uncommon in sporadic cases of HS (~6%). 21 γ-secretase activity in the skin