Altered Skin and Gut Microbiome in Hidradenitis Suppurativa
Open accessAbstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the formation of nodules, abscesses, and fistulae at intertriginous sites. The skin-gut axis is an area of emerging research in inflammatory skin disease and is a potential contributory factor to the pathogenesis of HS. A total of 59 patients with HS provided fecal samples and nasal and skin swabs of affected sites for analysis. A total of 30 healthy controls provided fecal samples, and 20 healthy controls provided nasal and skin swabs. We performed bacterial 16S ribosomal RNA gene amplicon sequencing on total DNA derived from the samples. Microbiome alpha diversity was significantly lower in the fecal, skin, and nasal samples of individuals with HS, which may be secondary to disease biology or related to antibiotic usage. Ruminococcus gnavus was more abundant in the fecal microbiome of individuals with HS, which is also reported in Crohn's disease, suggesting comorbidity due to shared gut microbiota alterations. Finegoldia magna was overabundant in HS skin samples relative to that in the healthy controls. It is possible that local inflammation is driven by F. magna by promoting the formation of neutrophil extracellular traps. These alterations in both the gut and skin microbiome in HS warrant further exploration, and therapeutic strategies, including fecal microbiota transplant or bacteriotherapy, could be of benefit.
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In advanced hidradenitis suppurativa with tunnel formation and fibrosis, surgical management remains essential, often combined with medical therapy to control inflammation and prevent recurrence.
“In advanced diseases with tunnel formation and fibrosis, surgical management remains essential, often combined with medical therapy to control inflammation and prevent recurrence [40,44,45,46,47].”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [40]
Neutrophils contribute to tissue injury in hidradenitis suppurativa through proteases, reactive oxygen species, and neutrophilic extracellular traps.
“Neutrophils contribute to tissue injury through proteases, reactive oxygen species, and neutrophilic extracellular traps (NETs).”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [40]
Epithelium-lined tunnels in hidradenitis suppurativa act as immunologically active niches, maintaining chronic inflammation and impairing resolution.
“The resulting epithelium-lined tunnels act as immunologically active niches, maintaining chronic inflammation and impairing resolution [40,41].”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [40]
Hidradenitis suppurativa represents a reprogrammed cutaneous microenvironment in which epithelial dysfunction, immune dysregulation, microbial persistence, and stromal remodeling are tightly integrated.
“Thus, hidradenitis represents a reprogrammed cutaneous microenvironment in which epithelial dysfunction, immune dysregulation, microbial persistence, and stromal remodeling are tightly integrated [40,41,42].”
From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [40]
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The Role of Human Gut Microbe Ruminococcus gnavus in Inflammatory Diseases
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The Current Clinical Trial Landscape for Hidradenitis Suppurativa: A Narrative Review
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Consistency of Bacterial Triggers in the Pathogenesis of Hidradenitis Suppurativa
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Comparative diet-gut microbiome analysis in Crohn’s disease and Hidradenitis suppurativa
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IL-17 Control of Cutaneous Immune Homeostasis
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Hidradenitis Suppurativa Tunnels: Unveiling a Unique Disease Entity
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Role of Antigenic Stimulation in Cutaneous T-Cell Lymphomas
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An Atlas of the Hidradenitis Suppurativa Transcriptome
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Genital Lichen Sclerosus—The Role of the Vulvar Microbiome
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Emerging Roles of Ferroptosis in Skin Pathophysiology
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Microbiome Perturbations in Hidradenitis Suppurativa
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Gut Microbiome in Adult and Pediatric Patients With Hidradenitis Suppurativa
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Intestinal Microbiomics in Physiological and Pathological Conditions
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Hidradenitis Suppurativa: A Literature Review Comparing Current Therapeutic Modalities
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Bidirectional Risk Association Between Hidradenitis Suppurativa and Inflammatory Bowel Disease
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Mucocutaneous manifestations of inflammatory bowel disease
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Meta-inflammation in Hidradenitis suppurativa: from pathogenic evidence to therapeutic approaches
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Advances in Probiotics for Health and Nutrition
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GUT AND SKIN MICROBIOME IN PATIENTS WITH HIDRADENITIS SUPPURATIVA
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Obesity, skin disorders, and the microbiota: Unraveling a complex web
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Hidradenitis suppurativa patients exhibit a distinctive and highly individualized skin virome
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Molecular analysis of inflammatory diseases
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“The resulting epithelium-lined tunnels act as immunologically active niches, maintaining chronic inflammation and impairing resolution [40,41].”
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Symposium on Hidradenitis Suppurativa Advances 2025 Proceedings
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SnapshotDx Quiz: February 2022
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Moata, H., Hali, F., Diouri, M., & Chiheb, S. (2024) · World Journal of Advanced Research and Reviews · doi:10.30574/wjarr.2024.21.3.0997
Effect of Gut Microbiome on Skin Microbiome
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“The Role of Diet in Hidradenitis Suppurativa”
Doughty, H., & Fragoso, N. M. (2025) · Current Dermatology Reports · doi:10.1007/s13671-025-00485-9
Pharmacomicrobiomics in inflammatory skin diseases: past, present, and the future
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Life towards death: Neutrophils in immune-mediated inflammatory diseases
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Alcohol Use and Hidradenitis Suppurativa: An Unclear Relationship
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Ye, Q., Hou, Z., Wang, R., Zhang, C., Yang, Y., Li, Y., Wang, B., & Yan, Y. (2026) · Dermatologic Therapy · doi:10.1155/dth/7323326
Evaluation of Serum Zonulin Levels and Intestinal Permeability in Hidradenitis Suppurativa Patients
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Exposome Versus Genome in HS: How Do We Currently Explain Where Disease Arises from?
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Post‐Transcriptional Regulators of Inflammation: The Role of microRNAs in Acne Inversa Pathogenesis
Bahashwan, E. (2026) · Journal of Biochemical and Molecular Toxicology · doi:10.1002/jbt.71072
Ye, Q., Li, Y., Zhang, C., Tang, X., Lai, X., Zhu, L., He, Y., Yan, Y., & Wang, B. (2026) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2026.09.025
Hidradenitis suppurativa skin microbiome: In‐depth analysis and modulation by systemic therapies
Amar, Y., Baumann, D., Niedermeier, S., Silva, R. L., Walch, S., Schloter, M., Köberle, M., Biedermann, T., & Volz, T. (2026) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.70813
- Authors
- McCarthy, S., Barrett, M., Kirthi, S., Pellanda, P., Vlckova, K., Tobin, A.-M., Murphy, M., Shanahan, F., & O’Toole, P. W.
- Affiliations
- National University of Ireland (IE)
- Tallaght University Hospital (IE)
- University College Cork (IE)
- Corresponding author
- McCarthy, Siobhán
- ORCID
- Venue
- Journal of Investigative Dermatology
- Publisher
- Elsevier BV
- Published
- 2022-02
- Volume
- 142
- Issue
- 2
- Pages
- 459-468.e15
- ISSN
- 0022-202X (ISSN-L)
- OpenAlex
- W3192488252
- Cited by
- 98
- References
- 80
- Citations by year
- 2026: 21 · 2025: 25 · 2024: 20 · 2023: 14 · 2022: 15 · 2021: 3
- FWCI
- 11.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Investigative Dermatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Science Foundation Ireland (APC/SFI/12/RC/2273_P2)
- University College Cork
- Topics
- Health Sciences › Medicine › Dermatology › Hidradenitis Suppurativa and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Microbiology › Actinomycetales infections and treatment
- Keywords
- hidradenitis suppurativa, skin microbiome, gut microbiota, gut-skin axis, Ruminococcus gnavus, Finegoldia magna, microbiome diversity, antibiotic use, neutrophil extracellular traps, fecal microbiota transplantation, bacterial therapy
- MeSH terms
- Eubacteriales, Bacillota, Gastrointestinal Microbiome, Fecal Microbiota Transplantation, Adult, Aged, Feces, Female, Humans, Male, Middle Aged, Skin, Case-Control Studies, Hidradenitis Suppurativa, Young Adult, Extracellular Traps
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