Hidradenitis suppurativa (HS) is a chronic inflammatory disease, characterized by painful, purulent and destructive skin alterations in intertriginous areas.

We investigated the expression and role in HS of granulocyte colony‐stimulating factor (G‐CSF), the regulator of neutrophil biology, as clinical signs of a neutrophilic granulocyte‐driven inflammation are distinctive in the disease.

Skin and blood samples obtained from different cohorts of patients with HS and control individuals were assessed by RNA sequencing, quantitative polymerase chain reaction on reverse transcribed mRNA, and/or enzyme‐linked immunosorbent assay. Mechanistic studies using keratinocytes, dermal fibroblasts, immune cell populations and skin biopsies were performed.

G‐CSF was abundant in HS skin, particularly in inflamed nodules and abscesses. Its levels even exceeded those found in other inflammatory skin diseases. Interleukin (IL)‐1 and IL‐17, respectively, induced G‐CSF production by fibroblasts and keratinocytes. These effects were enhanced by tumour necrosis factor (TNF)‐α and IL‐36. Accordingly, fibroblasts separated from HS lesions expressed G‐CSF, and IL‐1 receptor antagonist reduced G‐CSF levels in explanted HS skin. G‐CSF blood levels positively correlated with severity of HS. Elevated lesional G‐CSF receptor levels were linked to upregulation of molecules that contribute to prolonged activation of neutrophils by components of bacteria and damaged host cells [formyl peptide receptor 1 (FPR1), FPR2 and free fatty acid receptor 2 (FFAR2)], neutrophil survival [TNF receptor superfamily member 10C (TNFRSF10C/TRAIL‐R3) and TNF receptor superfamily member 6B], kinases (tyrosine‐protein kinase HCK and hexokinase 3), and skin destruction [MMP25 (matrix metalloproteinase 25) and ADAM8 (disintegrin and metalloproteinase domain‐containing protein 8)]. G‐CSF elevated the expression of FPR1, FFAR2, and TNFRSF10C/TRAIL‐R3 in neutrophils and synergized with bacterial components to induce skin‐destructive enzymes.

The G‐CSF pathway engages both tissue and immune cells, is strongly activated in HS lesions, and offers the opportunity to target the neutrophil‐driven inflammation.