Female Predominance of HS Associated with Earlier Age of Onset, Diagnosis

The female predominance of hidradenitis suppurativa (HS) was linked with earlier age of onset and age at diagnosis, according to recent data, and no significant correlations between age of onset, family history, or age at diagnosis have been observed.1

These findings and others were the result of a recent systematic review and meta-analysis of available data related to HS and its prevalence. Ilya Mukovozov, MD, PhD, and a team of other investigators led this analysis, noting beforehand that pediatric-onset HS had been widely accepted as rare.

Despite this conclusion, Mukovozov and coauthors noted the lack of established data on HS’s global prevalence.2 They further highlighted the lack of consensus related to the average age of disease onset, family history of the disease, and patients’ age at the time of diagnosis.

“Knowledge of the genetic influences of HS can also empower patients to watch for early signs of the disease in their families,” Mukovozov and colleagues wrote.1 “This study aimed to determine the prevalence, age of onset, age at diagnosis, and proportion of patients with a family history of HS in pediatric populations.”

Systematic Review and Meta-Analysis

The investigative team carried out their systematic search, using a set of 5 databases up to May 2024 and implementing search terms related to “hidradenitis suppurativa” and “pediatrics.” The team had 2 reviewers independently screen available literature for eligibility, resolving any disagreements via a third reviewer. They also checked reference lists of included papers for the purposes of identifying any additional studies.

Studies deemed eligible were observational in design and focused on participants who were younger than 18 years and reported having a clinical diagnosis of HS. Due to variability in the designs of these studies, only those with comparable approaches—specifically, population-based analyses of administrative or chart data that relied on ICD-9 diagnostic codes—were included by Mukovozov et al.

They did not include research that utilized surveys or alternative diagnostic methods. The investigators made no restrictions based on language. To qualify, studies also needed to report at least 1 of the following: disease prevalence, age at the time of onset, age at one's diagnosis, or family history of HS. The team carried out extraction of data in duplicate with a standardized template, recording study characteristics, patient demographic information, and relevant outcomes. The quality of each study was assessed independently by 2 reviewers through the Joanna Briggs Institute checklists.

Findings on Hidradenitis Suppurativa Prevalence

In total, there were 37 observational studies encompassing 6941 pediatric patients from 13 countries met Mukovzov and colleagues' criteria for inclusion. The weighted mean age across cohorts was 14.7 years, with reported ethno-racial distribution being as follows: Black (38.3%), White (36.5%), Hispanic (13.9%), Indigenous (0.2%), Asian (0.8%), Middle Eastern (0.7%), multiracial (1.2%), and unspecified (8.4%). In their assessment of disease severity, descriptions revealed that 42.5% of subjects were classified as Hurley Stage I, 46.3% as Stage II, and 11.2% as Stage III.1

Mukovozov and coauthors highlighted the pooled prevalence of pediatric HS was .03% (95% CI: 0.0001–0.0005). Most patients were shown to be female (78%, 95% CI: 0.76–0.80). The investigative team noted that a family history of HS was documented in 38% of the observed cases (95% CI: 0.30–0.45) and that the average age of HS onset had been 11.3 years (95% CI: 10.15–12.39). The team noted, however, that the mean age at diagnosis was 14.0 years (95% CI: 12.65–15.28).1

This suggests that there is a diagnostic delay. Female predominance of the condition was linked to earlier onset and earlier diagnosis, while there were no significant associations found between family history and either age of onset or age at diagnosis.

“We highlight the importance of early diagnosis and intervention to prevent disease progression and reduce psychosocial and physical sequelae,” they concluded.1 “Enhancing awareness among pediatricians and primary care providers of HS's varied presentations is crucial, possibly through the incorporation of HS into residency and continuing medical education curricula.”

References

1. G Xiong, M Ali, EG Kakhki, et al. Prevalence, Age of Onset, Age at Diagnosis, and Family History of Hidradenitis Suppurativa in Pediatric Populations: A Systematic Review and Meta-Analysis. Pediatric Dermatology (2025): 1–7, https://doi.org/10.1111/pde.70022.

2. Vaiopoulos AG, Nikolakis G, Zouboulis CC. Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature. J Eur Acad Dermatol Venereol. 2020 Sep;34(9):2140-2146. doi: 10.1111/jdv.16520. Epub 2020 Jun 22. PMID: 32324936. Accessed September 6, 2025.