Hessam S, et al. - Researchers from Germany explored whether the cytokine interleukin-36 (IL-36) could be fundamental in the development of hidradenitis suppurativa (HS). Elevated levels of all three subtypes of IL-36, as well as an imbalance of cytokines IL-37 and IL-38, which oppose the action of IL-36, were found in skin samples from 15 patients with moderately severe or severe HS. These results suggest an important role in the development of HS was played by the immune system, and may support the premise that high IL-36 levels start a chain reaction, with other interleukins and T-helper cells, that trigger inflammation and sufficient white blood cells to produce pus, which is a major feature of HS.