Hidradenitis Suppurativa Groin

A 28-year-old obese woman (BMI 34) who smokes one pack daily presents with a 5-year history of recurrent painful inflammatory nodules and abscesses in the axillae, inframammary folds, and inguinal region. She has undergone multiple incision and drainage procedures and antibiotic courses without sustained improvement. On examination, the inguinal folds show multiple inflammatory nodules, draining abscesses, and the pathognomonic finding of interconnected sinus tracts with hypertrophic rope-like scarring as marked **A** in the diagram. Her sister has a similar skin condition. Which of the following best explains the pathogenic mechanism underlying the formation of the sinus tracts and scarring marked **A**?