Disparities in Hidradenitis Suppurativa: A Closer Look at Skin of Color Populations

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Although the exact etiology of hidradenitis suppurativa (HS)remains unknown, it is believed to stem from a complex interplay of genetic factors, immune dysregulation, and environmental triggers.Notably, risk factors such as obesity, smoking, and hormonal changes contribute to the disease's complexity.¹ HS significantly impairs patients' quality of life and is linked to both physical and mental health challenges, which are often correlated with disease severity.²

Demographics and Prevalence

A recent review found that HS exhibits higher prevalence and incidence rates in skin of color (SOC) populations, particularly among Black/African American and Hispanic individuals.³ Studies included in the review showed that the prevalence rates of HS among African Americans can be 2.0- to 3.1-fold higher than those among white patients.⁴ In a study involving 366 patients diagnosed with HS, 54.4% were Black, 25.7% were White, and 19.9% were classified as 'other'.⁵ Despite the evident prevalence ofHS among minorities, the review found that representative recruitment is not always reflected in research studies.

Comorbidities Associated with HS

Researchers noted that HS is associated with various comorbidities, which can differ significantly among racial demographics. For instance, studies indicated that African American patients with inflammatory bowel disease are disproportionately affected by HS, suggesting potential genetic predispositions.⁶ Among patients with HS, anemia was also prevalent, with about 41.3% of individuals affected—60.6% of whom are African American.⁷

Pregnancy introduces additional risks for women with HS, particularly in SOC populations. The review found that pregnant women with HS are at increased risk for complications such as preeclampsia, cesarean delivery, and congenital abnormalities in their offspring. These risks are notably higher in African American women, emphasizing the need for careful monitoring and patient education regarding obstetric complications.⁸

Healthcare Utilization and Disease Severity

The review found that African American patients are significantly more likely to visit emergency departments and require hospitalizations for HS-related issues compared to White patients. Researchers stated that African Americans average 5.2 healthcare visits for HS in a 5-year span, compared to 4.7 for White patients and 7.2 visits for Hispanic patients. This increased utilization reflects a greater disease burden, as indicated by higher Hurley stage scores, which measure disease severity.⁹

Diversity in Clinical Trials

Despite the significant impact of HS on SOC populations, the review found there is a marked underrepresentation of these groups in clinical trials. A review of 15 HS randomized controlled trials conducted between 2000 and 2019 revealed that 68% of participants were White, while only 14% identified as African American. Researchers said this lack of diversity in research limits the understanding of treatment efficacy across different racial backgrounds, potentially affecting the quality of care provided to SOC patients.

Conclusion

Overall, the review found that HS disproportionately affects individuals of color, particularly African American and Hispanic populations, who experience more severe manifestations and a higher incidence of comorbidities. There is an urgent need for more inclusive research that examines the experiences and outcomes of HS across diverse ethnic groups. Current literature has identified critical gaps regarding the impact of HS on various populations, particularly in understanding the experiences of Asian, Native American, and other minorities.

Researchers suggested that addressing the disparities in HS management requires a multifaceted approach, including increased representation of SOC patients in clinical trials. By enhancing diversity in research and healthcare policies, clinicians can better understand the disease's impact and improve management strategies for all individuals affected by HS. Tailored approaches that consider the unique challenges faced by SOC populations are essential for providing effective care and improving quality of life for these patients. The review stated that future research should actively seek to broaden our understanding of HS across diverse ethnic groups, ensuring that all patients receive equitable and effective treatment.

References

1. Diaz MJ, Aflatooni S, Abdi P, et al. Hidradenitis suppurativa: Molecular etiology, pathophysiology, and management-A systematic review. Curr Issues Mol Biol. 2023;45(5):4400-4415. Published 2023 May 17. doi:10.3390/cimb45050280
2. Alavi A, Anooshirvani N, Kim WB, et al. Quality-of-life impairment in patients with hidradenitis suppurativa: a Canadian study. Am J Clin Dermatol. 2015;16(1):61-65. doi:10.1007/s40257-014-0105-5
3. Prieto K, Lovell KK, Feldman SR, et al. Special considerations for hidradenitis suppurativa in skin of color: A review of literature. JEADV Clin Pract. 2024; 1–5. https://doi.org/10.1002/jvc2.549
4. Zouboulis CC, Goyal M, Byrd AS. Hidradenitis suppurativa in skin of colour. Exp Dermatol. 2021;30 Suppl 1:27-30. doi:10.1111/exd.14341
5. Reeder VJ, Mahan MG, Hamzavi IH. Ethnicity and hidradenitis suppurativa. J Invest Dermatol. 2014;134(11):2842-2843. doi:10.1038/jid.2014.220
6. Ramos-Rodriguez AJ, Timerman D, Khan A, et al. The in-hospital burden of hidradenitis suppurativa in patients with inflammatory bowel disease: a decade nationwide analysis from 2004 to 2014. Int J Dermatol. 2018;57(5):547-552. doi:10.1111/ijd.13932
7. Resnik SR, Geisler EL, Reyes N, et al. Prevalence and risk factors for anemia in a population with hidradenitis suppurativa. Cureus. 2020;12(12):e12015. Published 2020 Dec 10. doi:10.7759/cureus.12015
8. Althagafi H, Spence AR, Czuzoj-Shulman N, et al. Effect of hidradenitis suppurativa on obstetric and neonatal outcomes. J Matern Fetal Neonatal Med. 2022;35(25):8388-8393. doi:10.1080/14767058.2021.1974833
9. Kilgour JM, Li S, Sarin KY. Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: A retrospective analysis of 2 U.S. cohorts [published correction appears in JAAD Int. 2021 Apr 13;3:88. doi: 10.1016/j.jdin.2021.03.006]. JAAD Int.2021;3:42-52. 2021. doi:10.1016/j.jdin.2021.01.007