In order to clarify the role of adalimumab and other anti-TNF involved in HS paradoxical reactions, including infliximab and etanercept, an imbalance has been supposed, induced by TNF blockage in the cytokine pool and a consequent activation of type I interferon or IL 1 beta, together with the possible role of occult infections [51,52]. Here, IL1B is linked to infection.