Racial and ethnic disparities in hidradenitis suppurativa: a review for PAs

Hidradenitis suppurativa (HS) is a chronic, painful, immune-mediated inflammatory skin disease marked by recurrent nodules, abscesses, and draining sinus tracts in intertriginous regions. Although frequently under-recognized and subject to an average diagnostic delay exceeding a decade, HS does not affect all populations equally. United States epidemiologic data consistently demonstrate that Black and African American patients experience a higher incidence of HS, earlier age of onset, and greater disease severity, including nearly 3-fold higher odds of advanced (Hurley stage III) disease, than White patients, alongside a heavier burden of medical comorbidity. These disparities extend beyond biology, arising from an interplay of genetic, environmental, socioeconomic, and structural factors. Racial and ethnic minority patients face longer diagnostic delays, reduced access to dermatologic care, and persistent under-representation in the clinical trials that define the HS evidence base, while the substantial psychosocial burden of the disease, including elevated rates of depression, anxiety, and suicidality, further compounds these inequities. This article reviews the evidence for racial and ethnic disparities in HS across epidemiology, disease severity, social and structural determinants of care, psychosocial impact, and clinical trial representation. Because physician assistants frequently serve as the first point of clinical contact for patients with HS, they are uniquely positioned to shorten diagnostic delay and advance equitable care through earlier recognition, timely referral, and culturally responsive, patient-centered management.