Microbiome in Hidradenitis Suppurativa: Current Evidence and Practice

Purpose The role of the host microbiome in hidradenitis suppurativa (HS) is heavily debated. Previous culture-based methods have not led to strong conclusions. Despite antibiotics being a mainstay of HS treatment, microbiome research in other cutaneous inflammatory diseases such as atopic dermatitis and psoriasis is more robust. This review evaluates the current evidence regarding the influence of skin and gut dysbiosis on HS pathogenesis. Current and potential future microbiome modulating therapeutic modalities are also discussed. Recent Findings Newer studies using 16S genome sequencing have furthered our understanding of the human microbiome. We find promising evidence for cutaneous dysbiosis but limited evidence for gut dysbiosis. Summary Both areas need future studies focusing on the temporal relationship between the microbiome and disease flare and remission and the impact of treatments on the microbiome. Detailed knowledge of microbial shifts will lead to innovations in diagnosis and treatment in the era of precision medicine.