Is hidradenitis suppurativa more an autoinfection than pure autoinflammation?

Hidradenitis suppurativa is currently considered an autoinflammatory disease. However, the cause of this inflammation remains unknown. Over the past 18 years, we have followed a cohort of 1,700 patients with hidradenitis suppurativa and identified, both in the literature and in our daily practice, several arguments suggesting that hidradenitis suppurativa represents a new concept of host-microbiome disease. This concept is based on an inborn error of immunity localized to a single organ-the skin-or, in special cases, to two or more organs. In this article, we detail the microbiological, immunologic, metabolomic, therapeutic, and genetic evidence supporting the view that HS should be redefined as an autoinfectious rather than a purely autoinflammatory disease.