Management of Hidradenitis suppurativa patients having underlying genetic variation - a systematic review and a call for precision medicine

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the pilosebaceous unit characterised by inflammation and hyperkeratinisation at the pilosebaceous unit. A small, but significant proportion of HS patients have a strong genetic susceptibility to (or a syndromic form of) the disease. Current HS treatment guidelines prioritise patients who manifest classic HS and may therefore not be reproducible for the minority of patients harbouring genetically driven forms of disease. In this manuscript, we review the extant literature with regards to therapeutic strategies employed for patients with HS having disease-associated genetic variants as well as syndromic forms of the condition. The findings of this review suggest that HS patients harbouring underlying genetic variants may not be adequately represented in current European and British HS treatment guidelines. Moreover, these patients may be less responsive to the recommended therapeutic options. In this context, we make recommendations for future therapeutic guidelines to incorporate considerations for the management of this patient subset.