A 26-year-old woman presents with a 9-month history of recurrent painful “boils” in both axillae and the groin. She reports intermittent drainage of foul-smelling fluid that stains her clothes. Episodes last weeks and have become more frequent. She smokes 1 pack of cigarettes daily. Physical examination shows multiple tender, deep nodules and fluctuant abscesses in the axillae with several open comedone-like blackheads and fibrotic scarring; a few lesions have small openings that express malodorous purulent material with pressure. Which of the following best describes the underlying pathogenesis of this patient’s condition?

A. Neutrophilic inflammation of the pilosebaceous unit due to Cutibacterium acnes overgrowth B. Occlusion of folliculopilosebaceous units in intertriginous areas leading to chronic inflammation and sinus tract formation C. Steroid-induced monomorphic papules caused by increased sebum production without comedones D. Hyperkeratinization of follicular epithelium causing open and closed comedones predominantly on the face E. Tobacco use leading primarily to TNF-α production by keratinocytes with no role in follicular occlusion