The Understudied Landscape of Hidradenitis Suppurativa in Asian Skin of Colour Populations

The article by Prieto et al. [1] was an interesting read and brings attention to the disproportionate burden of hidradenitis suppurativa (HS) among patients with skin of colour (SOC), particularly African American and Hispanic populations. However, a significant underrepresentation of Asian population has been noted throughout the review. While the article highlights limited data on Asian populations, a PubMed and Google Scholar search reveals several regional studies from various parts of Asia that contribute valuable insights into the epidemiology and clinical presentation of HS. Though the article [1] appropriately frames HS within the context of skin of colour, it is important to recognise that SOC is not a homogenous category. Asia is a highly heterogeneous region comprising numerous racial and ethnic groups, with the period prevalence of HS reported to be 0.06% [2]. Asian populations—encompassing East Asia (e.g., China, Korea, Japan), Southeast Asia (e.g., Singapore, Malaysia), and South Asia (e.g., India, Pakistan, Bangladesh)—span a broad spectrum of Fitzpatrick skin types (III to VI), each with distinct epidemiological and disease patterns. Central (Kazakhstan, Uzbekistan, Turkmenistan) and Western Asia (Saudi Arabia, UAE) differ in skin phenotype (Fitzpatrick 2–4) and ethnic composition compared to the rest of Asia.

Among the Southeast Asian cohorts from Singapore and Malaysia, Indian patients appear disproportionately affected by HS while Chinese patients are underrepresented relative to national census data [2]. A recent systematic review and meta-analysis of 30,125 patients from East and Southeast Asia highlights distinct demographic and clinical patterns, revealing a male predominance (66%), lesion distribution favoring the axilla and gluteal area, and a notably low rate of familial HS (5%) compared to Western cohorts (30%). The male predominance in Asian HS populations has been attributed, in part, to significantly higher smoking rates among Asian men, in contrast to Western cohorts where smoking prevalence is balanced between males and females [3]. Lesional distribution in HS shows some overlap between East Asia and Western countries, though the commonly involved sites differ. In East Asian cohorts like Korea and Japan, gluteal involvement is more common especially among males, whereas axillary involvement dominates among females. In contrast, Southeast Asian studies from Singapore and Malaysia consistently report the axilla as the most affected site, possibly due to climatic factors like higher humidity and sweat-induced follicular occlusion [2]. Only around 5% of Asian HS patients report a positive family history, compared to approximately 30% in Western populations—a difference that may be influenced by rising obesity rates in Asia unmasking sporadic cases, and the predominance of Caucasian participants in Western studies, where familial HS is more common. Interestingly, although monogenic HS is rare overall, mutations in the γ-secretase pathway have been more frequently identified in Asian patients, pointing to a distinct genetic profile that merits further exploration. There is a clear paucity of published data representing South Asian countries such as India, Bangladesh, Nepal, and Pakistan, limiting our understanding of HS epidemiology and clinical patterns in these diverse and densely populated regions. Again, Asian cohorts, particularly from South Asia, remain underrepresented in HS research and clinical trials—a gap noted in recent reviews emphasising the need for more inclusive and regionally representative studies [3]. Table 1 provides a geographic depiction of phenotypic, epidemiological, and genetic features of HS across different parts of Asia in comparison to the Western population (a few prototypic examples of countries within each region are provided in parentheses). These findings highlight phenotypic heterogeneity in HS and underscore the importance of incorporating Asian data into future research, guidelines and treatment paradigms.

Anju George: conceptualisation, literature review, manuscript drafting and editing. The author has read and approved the final manuscript.

The author has nothing to report.

The author declares no conflicts of interest.