Healthcare Disparities in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a lifelong skin condition.¹ With this condition, irritation causes infections and itchy/painful bumps the size of a pea or marble to form on the skin. HS leads to pain, swelling, foul odor, boils, scars, and embarrassment. It can appear anywhere skin rubs together, like the:^1-3

• Armpit
• Groin
• Buttocks
• Breasts

HS affects every race and age. It occurs in 0.3 percent to 4 percent of people in the United States. But no one knows its exact cause. The risk of HS rises in smokers and people who weigh more. HS risk is also high in people with health conditions like heart disease, diabetes, and stroke.^1,2

Are there healthcare disparities in HS?

Absolutely. Everyone does not have the same access to healthcare.

“Healthcare disparity” is a term doctors use to explain differences in health between groups of people. These differences may be caused by age, race, income, health conditions, or where they work or live.

The Center For American Progress finds that Black and Hispanic people receive less health coverage than non-Hispanic whites. People of color have more health problems but fewer diagnoses or treatment.³

Black and Hispanic people rarely go to healthcare providers or specialists like skin doctors. They may ignore their HS symptoms and accept them as a part of life. This leads to less documentation about HS in people of color. This, in turn, limits us from seeing the complete picture of people affected by HS.¹

Who has HS?

Healthcare disparities make it challenging to identify the people affected by HS. HS may be more common in young adults and women.

It may also be more common in people of color. Several studies support this idea. But most HS studies have included more white people than Black or Hispanic people.²

It is also true that it is hard to be certain about any of this information, because there are so few studies and some of them don’t agree. One Minnesota study actually showed about a 90 percent majority of white people among those with HS. But this may be because most people who live in Minnesota are white. Regardless, more research is needed.²

What we do know is that there are few to no studies of HS in people of color. And there is no research about infections suffered because of HS.²

Is there a link between socioeconomic status and HS?

Unfortunately, there is.

A study done in the Bronx, New York, found that HS is more common and severe in people of low socioeconomic status (SES).⁴

What drugs are used to treat HS in people of color?

Humira® (adalimumab) is currently the only drug prescribed for HS. Unfortunately, most of the people in the study trial for Humira were white. Black and Hispanic people were underrepresented. No study shows how Humira works on people of color.⁴

There is also little research from Southeast Asia and Africa about HS on the people of color who live there. Cost limits the use of Humira and other drugs in these countries. So they use benzoyl peroxide, dapsone, azelaic acid, and zinc supplements. There is limited data about whether these remedies work.⁵

Conclusion about HS in people of color

There are a few problems with reaching any conclusion about HS without more studies. For starters, one problem is that each study that does exist was conducted in a single center. HS might be undiagnosed or misdiagnosed in a given facility that conducted the research.

More research needs to be done on HS. Only when there are more studies can we know who is more likely to have it, how much more likely, and how to treat it in different groups of people.