Racial Differences and Disparities in Hidradenitis Suppurativa Care

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that can profoundly impact patients’ quality of life. Characterized by painful abscesses, nodules, and sinus tracts, HS typically appears in intertriginous areas, such as the axillae, inguinal region, and gluteal folds.

While HS affects 1 percent of the global population, there is a notably higher prevalence in individuals with skin of color (SOC), especially African Americans. However, our understanding of HS in patients with SOC remains limited, largely due to underrepresentation of racial minorities in clinical trials.

The Impact of HS on African American Patients

Recent research has begun to shed light on the clinical characteristics of HS in the African American population, where the prevalence rates are estimated to be two to three times higher than in Caucasian patients. Additionally, African American patients with HS are more likely to:

• Experience more severe manifestations and present with more advanced disease stages
• Experience comorbidities, including inflammatory bowel disease and anemia
• Require emergency department care and hospitalization
• Undergo surgical interventions, including excision of affected areas

Additionally, African American patients with HS who are pregnant are more likely to experience adverse outcomes such as preeclampsia, caesarean delivery, and congenital abnormalities, which may be exacerbated by disease severity or pharmacological management of HS.

While these factors necessitate specialized diagnostic and therapeutic approaches, treatment options remain limited, with the current standard including topical medications, systemic therapies, and surgical procedures. The biologic adalimumab is currently the only FDA-approved treatment for HS, and phase 3 trials have demonstrated a clinical response in 50 percent of patients. As additional treatment options are explored in clinical trials, the particular characteristics of HS in African American patients are important to consider.

Addressing Gaps in Research

Tailored management is crucial for optimizing outcomes in African American patients with HS. Despite the disproportionately high prevalence of HS on this population, research specifically focusing on their needs remains sparse, limiting our understanding of how available therapies may perform differently for them. Collecting comprehensive data from racially diverse populations is key to inform personalized treatment strategies.

Additionally, there is limited research examining the impact of HS in other racial and ethnic groups. An improved understanding of the disease’s impacts across diverse groups could inform management strategies and facilitate the development of more targeted therapeutic approaches. To address these gaps, future research can prioritize inclusivity in clinical trials, ensuring that diverse populations are adequately represented. This approach can help advance the understanding of various presentations of HS, supporting the development of more effective and equitable management approaches.

At this week's Maui Derm conference, a panel of experts will expand upon ethnic differences in the presentation of various skin conditions, and Dr. Vivian Shi will share therapeutic and surgical management strategies for HS. Tune in to hear the latest findings.

References

Krueger, J. G., et al. (2024). Hidradenitis suppurativa: New insights into disease mechanisms and an evolving treatment landscape. Br J Dermatol, 190(149-162). doi.org/10.1093/bjd/ljad345

Prieto, K., Lovell, K. K., Feldman, S. R., & Pichardo, R. O. (2024). Special considerations for hidradenitis suppurativa in skin of colour: A review of literature. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.549