Physician Knowledge,Attitudes,and Perspectives Toward Hidradenitis Suppurativa: A Systematic Review

To the Editor,

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful lesions. Despite its impact on quality of life, HS has an average diagnostic delay of 10 years. ¹ Longer diagnostic delay in HS has been associated with greater disease severity at diagnosis. ¹ Though the reasons for this remain largely unknown, variability in physician knowledge, attitudes, and perspectives regarding HS may contribute to these diagnostic challenges. ² Patients have also expressed the desire for healthcare professionals who are knowledgeable about both the clinical care and the overall burden of living with HS.^3,4 Addressing such gaps is critical to improving HS care delivery. Thus, this systematic review aimed to summarize physicians’ knowledge, attitudes, and perspectives toward HS.

We registered our systematic review in PROSPERO (CRD420251036486) and reported it following PRISMA 2020 guidelines (Supplementary Table 1). We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to April 3, 2025, for peer-reviewed studies reporting physician- and physician trainee-reported insights on HS (Supplementary Figure 1). Two reviewers (M.P. and D.R.) independently screened citations, extracted data, and evaluated risk of bias. Where applicable, findings were summarized using a narrative thematic approach.

A total of 1414 unique citations were screened, and 21 were included reporting on 1882 physicians (dermatologists, obstetricians/gynecologists, surgeons, family medicine physicians, and emergency medicine physicians; Supplementary Figures 2 and 3 and Supplementary Table 2).

We identified 6 narrative themes: (i) physicians have variable knowledge of HS; (ii) physicians’ confidence in managing HS varies, but increases with experience, especially for moderate to severe cases; (iii) physicians vary in which specialties they see as most involved in diagnosing and managing HS, but dermatologists and surgeons are most often identified as key providers of HS care; (iv) physicians report the importance of addressing psychological needs in HS; (v) physicians are willing to improve their knowledge of HS, but they perceive a lack of support and mentorship as a barrier to becoming HS experts; (vi) physicians report gaps in HS care, including treatment options, patient education, and access. Supporting evidence for these narrative themes is provided in Supplementary Table 3.

Our findings are consistent with educational deficits observed at the undergraduate medical level. In a national survey of U.S. medical students, HS was found to be ranked among the least familiar dermatological conditions, with most symptoms and treatments correctly recognized by only 20% to 50% of respondents, and fewer than one-third feeling confident in diagnosing the disease. ⁵ Such early training gaps may perpetuate limited provider familiarity and contribute to diagnostic delays observed in practice.

This is the first systematic review to summarize physicians’ knowledge, attitudes, and perspectives toward HS. All included studies were conducted in high-income or upper-middle-income countries, which can limit the generalizability to global settings, given that it may represent the viewpoints of physicians practicing in more resourced healthcare systems. Nonetheless, our review highlights 6 themes that collectively illustrate opportunities for improving HS education and care.