Underdiagnosis of Hidradenitis Suppurative Found

A study aimed to determine the prevalence of hidradenitis suppurative (HS) in the general adult population in the Northern Netherlands and to determine patient characteristics and comorbidities associated with HS.

Analysis of the prevalence of hidradenitis suppurative (HS) in the general population of the Northern Netherlands indicates that HS is underdiagnosed, according to findings from a study published in the British Journal of Dermatology.

The study aimed to determine the prevalence of HS in the general adult population in the Northern Netherlands and to determine patient characteristics and comorbidities associated with HS.

The data employed was collected through a survey-based study within the Lifelines Cohort Study, which is based on the general population living in the Northern Netherlands. A digital self-reported questionnaire was developed using validated questions for determining HS and was sent out to 135,197 potential participants. A total of 57,779 residents returned the questionnaire, yielding a 42.7% response rate. Of those, 56,084 respondents were eligible for analysis. Of the qualified respondents, 448 self-reported having a diagnosis of HS and 708 positively answered a combination of 2 validated diagnostic questions, confirming a total of 1,156 HS patients of 56,084 respondents, thereby producing an overall prevalence of 2.1%.

The prevalence of HS in the general population is approximated to be 1%, the study authors noted. When that number is compared with the current finding of 2.1% it can be extrapolated from the difference, they believe, that HS has been underdiagnosed. This discrepancy could be due to a patient’s shame which prevents them from seeking medical attention, or lack of recognition on the part of the diagnosing physician.

Among other characteristics, the study collected data on gender and socioeconomic status. In all, 73.5% of respondents with HS were women, compared with 60.1% in the control group, representing a 2.5% prevalence of HS in women. Although men presented with a 1.3% prevalence of HS, the study findings demonstrated that “the female gender is associated with increased risk” for HS. In addition, HS was also associated with lower socioeconomic status. The analysis of the data from respondents with only low socioeconomic status found a 2.4% prevalence of HS.

HS is associated with a number of systematic comorbidities such as Crohn’s disease, diabetes mellitus, COPD, asthma, kidney disease, bladder dysfunction, and rheumatoid diseases, the investigators said. This study found that fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, and migraines are also associated with HS.

The researchers acknowledged that the study was limited by the self-reported HS diagnosis and by the older old of participants, which may have overlooked younger patients with HS.

Based on the collected data and subsequent analysis, the researchers found that the “overall questionnaire-based prevalence of HS was 2.1%, which indicates underdiagnosis of this debilitating skin disease.”

Disclosure: This research was supported by Novartis. Please see the original reference for a full list of disclosures.


Prens LM, Bouwman K, Troelstra LD, Prens EP, Alizadeh BZ, Horváth B. New Insights in Hidradenitis Suppurative from a Population-Based Cohort: Prevalence, Smoking Behavior, Socioeconomic Status and Comorbidities. British Journal of Dermatology. Published online December 18, 2021. doi:10.1111/bjd.20954