An Updated View of Racial and Ethnic Disparities in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with significant global burden and heterogeneous prevalence across populations. Disparities in HS are frequently attributed to racial and ethnic differences; however, both are social constructs that lack biological significance and therefore cannot account for these variations. While HS research has traditionally focused on the genetics and inflammatory pathways (i.e., intrinsic factors) that contribute to disease pathogenesis, emerging evidence has demonstrated that extrinsic factors like social determinants of health (SDoH) and structural determinants of health (StDoH) strongly influence disease onset, severity, and outcomes across populations. This review synthesises evidence on the influence of SDoH and StDoH on HS incidence, severity, and health disparities. Specifically, it emphasises the impact that SDoH have in shaping HS risk. Furthermore, it explores the overarching StDoH that create and maintain health inequities and examines the intricate relationship between these extrinsic factors and ancestry-linked biological differences. Understanding HS burden requires integrating both intrinsic susceptibility and extrinsic exposures. Future research must expand beyond traditional biomedical frameworks to account for social and structural context in clinical studies. This holistic approach will strengthen our understanding of HS and advance systemic interventions to reduce health inequities and improve patient outcomes.