Is Hidradenitis Suppurativa Underdiagnosed in Male Patients?

Hidradenitis suppurativa (HS) may affect males and females at similar rates when symptom patterns are counted alongside formal diagnoses, according to a retrospective US claims analysis presented at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada.¹ The findings challenge the long-reported female predominance of approximately 3:1 and suggest HS may be underdiagnosed in males.

The study was led by Hadar Lev-Tov, MD, of the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, with Amit Garg, MD, of Northwell, and colleagues. UCB funded the analysis.

How Was HS Prevalence Measured in the Komodo Health Analysis?

Investigators used the Komodo Health database, which includes more than 300 million US patients, with claims from October 2016 to December 2024. They reported age-adjusted, sex-specific annual prevalence from 2017 to 2024 for 2 mutually exclusive groups: patients with an HS diagnosis based on ICD-10 code L73.2 and patients with HS-related symptom-defined disease.

Symptom-defined disease required at least 5 claims on distinct dates for HS-related manifestations such as abscess, furuncle, and pilonidal cyst, without a formal HS diagnosis. Patients with 5 or more claims for pilonidal cyst alone were excluded, and all analyses were descriptive.

What Did the Prevalence Data Show by Sex?

The analysis included approximately 2.4 million patients, with about 1.6 million in the diagnosed HS group and about 0.8 million in the symptom-defined group.

Among patients with a formal diagnosis, prevalence in 2017 was 62 cases per 100,000 males and 148 cases per 100,000 females. The female predominance persisted through 2024, when prevalence reached 97 and 253 cases per 100,000 among males and females, respectively.

Symptom-defined disease showed a more balanced distribution with a slight male predominance. Prevalence was 43 cases per 100,000 males and 37 per 100,000 females in 2017, rising to 67 and 54 per 100,000, respectively, in 2024.

Is Hidradenitis Suppurativa Underdiagnosed in Male Patients?

The investigators concluded the similar prevalence of HS-related symptoms between sexes, in the absence of a formal diagnosis, runs contrary to the established view of HS as a markedly female-predominant disease. They noted the findings may point to underdiagnosis in males and highlight the need to reduce diagnostic disparities between male and female patients.

Because the symptom-defined group relied on claims for recurrent abscesses, furuncles, and pilonidal cysts rather than confirmed diagnoses, the analysis does not establish how many of these patients had HS. The data are descriptive and drawn from secondary care claims.

Editor's Note: This summary has been edited for grammar and clarity using artificial intelligence tools.

References

1. Lev-Tov H, Ingram JR, Hsiao J, et al. Sex-specific and age-adjusted prevalence of hidradenitis suppurativa: results from Komodo US claims data suggest sex parity of HS symptoms. Presented at: Fall Clinical Dermatology Conference 2026; October 8-11, 2026; Las Vegas, NV.

2. Ingram JR. The epidemiology of hidradenitis suppurativa. Br J Dermatol. 2020;183(6):990-998.

3. Ingram JR, Jenkins-Jones S, Knipe DW, Morgan CLI, Cannings-John R, Piguet V. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol. 2018;178(4):917-924.