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Hidradenitis suppurativa represents a chronic, recurrent inflammatory disease, characterized by the formation of painful abscesses, sinuous tracts, foul smelling secretions, vicious scaring, with a severe reduction of the patients' quality of life. The pathophysiology of hidradenitis suppurativa is complex, follicular hyperkeratosis being regarded as the main pathogenetic mechanism. Bacterial colonization and follicular dysbiosis are of secondary importance in the pathogenesis of the disease, by triggering immunemediated inflammation. The formation of bacterial biofilms in sinuous tracts inhibits the efficacy of antibiotics, thus inducing chronic lesions. This article aims to highlight the role of bacterial colonization in the pathophysiology of hidradenitis suppurativa, as well as therapeutic options that act by regulating follicular dysbiosis. [ABSTRACT FROM AUTHOR]