Topic 1: HS Often Begins Before Adulthood

HS is frequently thought of as an adult disease, but symptoms often begin during adolescence. A 2023 Pediatrics review reported that nearly one-third of HS cases occur in pediatric patients and that nearly half of patients recall initial symptoms during childhood.¹

A 2025 systematic review and meta-analysis found that pediatric HS commonly begins around early adolescence and that diagnosis often follows years later. Family history was reported in a substantial minority of pediatric cases, supporting a deliberate family-history question, with the understanding that its absence is not evidence against HS.²

HS is uncommon before puberty but can occur in younger children. Very early onset should prompt careful diagnostic confirmation and consideration of whether additional evaluation is needed, particularly when the presentation is atypical.