Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterised by the presence of painful nodules, abscesses, and scarring. Increasing attention is being directed toward the systemic component of HS, particularly in the context of metainflammation and metabolic disorders. Metainflammation, a chronic, low-grade inflammatory reaction associated with metabolic dysfunction, is increasingly recognized as a central driver in the pathophysiology of HS. Elevated levels of proinflammatory cytokines such as TNF-α, IL-1β, and IL-17 are detected not only in affected skin areas but also systemically. These cytokines perpetuate a persistent inflammatory state, exacerbating disease severity and establishing a bidirectional association with metabolic disorders.

HS patients frequently present with metabolic comorbidities, including obesity, dyslipidaemia, insulin resistance, type 2 diabetes mellitus, and cardiovascular disease. These associations underscore the complex interplay between chronic systemic inflammation and metabolic dysfunction, positioning HS as a disease with implications far beyond the skin.

This Research Topic of Frontiers in Immunology is dedicated to the significant yet underexplored nexus of metainflammation and metabolic disorders in hidradenitis suppurativa. Our aim is to provide a comprehensive overview of the pathophysiological mechanisms, clinical manifestations, and potential therapeutic targets arising from this intricate interplay. As HS research increasingly bridges immunology, endocrinology, and cardiology, this Research Topic seeks to highlight interdisciplinary perspectives and foster collaboration between specialists.

The goals of this Research Topic are threefold:

• Enhance understanding of HS as a systemic disease: Articles are encouraged to elucidate the immunological underpinnings of HS, with a focus on systemic cytokine profiles, immune cell dynamics, and the role of the skin as an immunological organ.

• Improve clinical care: Contributions that integrate metabolic screening protocols or explore therapeutic strategies targeting both inflammatory and metabolic pathways are highly welcome. Such approaches may include biologic therapies, lifestyle interventions, and combined modalities.

• Catalyse innovation in research and treatment: We invite submissions that present novel experimental data, preclinical models, or biomarker studies that inform HS management and the development of new therapeutic approaches.

Manuscripts that don't have a clear focus on immunological mechanisms are out of scope for this journal.

Topic Editor John Frew received financial support from Ortho Dermatologics, Sun Pharma, LEO Pharma, UCB, Almirall and La Roche Posay. Topic Editor Nessr Abu Rached received financial support from Novartis Pharma, Janssen-Cilag GmbH, Recordati Rare Diseases Germany GmbH, Therakos (UK) Ltd and Johnson & Johnson.

Topic Editor Falk G Bechara received financial support from AbbVie Inc., AbbVie Deutschland GmbH & Co. KG, Acelyrin, Beiersdorf, Boehringer Ingelheim Pharma GmbH & Co. KG, Celltrion, Dr. Wolff, Incyte Corporation, Janssen-Cilag GmbH, Johnson & Johnson, Merck, Mölnlycke, MoonLake, Novartis Pharma GmbH, Sanofi, Sitala and UCB Pharma.

Topic Editor Robert Sabat received financial support from AbbVie, Almirall Hermal, Amgen, Bayer Schering Pharma, Boehringer Ingelheim Pharma, Bruno Bloch Stiftung, Celgene/Amgen, Celgene/Bristol Myers Squibb, Charité Research Organization, CSL Behring, ICON, IQVIA RDS, Incyte, Janssen-Cilag/Janssen Research & Development, MoonLake Immunotherapeutics, Novartis Pharma, Parexel, Rheinische Friedrich-Wilhelms-Universität Bonn, Sanofi-Aventis, TFS, UCB Biopharma, Universitätsmedizin Greifswald, Wundnetz Berlin-Brandenburg.

The other Topic Editors declare no competing interests with regard to the Research Topic subject.

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Metainflammation and Metabolism in Hidradenitis Suppurativa