Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease affecting the axillae, perineum and inframammary regions, among other body sites. Accumulating evidence indicates a hair follicle (HF) focus to this disease, as it is characterized by an early occlusion, followed by rupture of the HF and more generalized skin inflammation. 1 HS is part of the follicular occlusion tetrad of disorders (HS, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus).It results in painful local nodules and abscesses that can develop into pus-filled malodorous sinus tracts, also known as tunnels, that may result in extensive scarring. 2,3 In addition to cutaneous inflammation, patients with moderate-to-severe HS have evidence of systemic inflammation, as measured by C-reactive protein (CRP) and highsensitivity CRP. 1,4-8 Thus, it is unsurprising that HS is associated with significant psychosocial morbidity and profoundly impaired patient quality of life, when compared to other inflammatory skin diseases such as psoriasis. [9][10][11][12] Aside from the obvious pain and discomfort of HS lesions, patients commonly experience mood disorders (eg depression), altered body image, stigmatization, social isolation and sexual dysfunction. 9,[12][13][14][15][16] Approximately 35% of HS cases in northwestern European cohorts display a positive family history which suggests a genetic component. 17 This is less in some Asian populations at approximately 5% of patients. 18,19 Environmental factors,