Increased Prevalence and Severity of HS in Black, Hispanic Patients

Black patients have higher prevalence of hidradenitis suppurativa (HS) compared with White patients and are more likely to be hospitalized, according to a presentation by Ginette A. Okoye, MD, FAAD, at Dermatology Week 2022.

A recent population-based study revealed that the prevalence of HS in the US is 0.1%. Women aged 30 to 39 make up the majority of that percentage, Dr. Okoye said at the start of her session. She added that Black patients were 2 to 3 times more likely than White patients to be hospitalized because of HS.

Furthermore, Dr. Okoye noted that HS had been linked to poor socioeconomic status (SES), obesity, and smoking. Patients with HS experience slower income growth, decreased yearly income, increased absenteeism, and an increased likelihood of leaving the workforce.

According to Dr. Okoye, Black and Hispanic patients with HS made the greatest number of visits to outpatient and emergency departments. They also had the greatest number of hospitalizations. In addition, Black and Hispanic patients exhibited more severe conditions. However, Hispanic patients were more likely to receive tertiary care earlier than Black patients.

“This issue of health disparities in HS is an interesting and complex one,” Dr. Okoye stated. “We already have an increased prevalence and severity of this disease in an already underserved and disadvantage group of patients, and so the question is why? Why does this happen?” she added.

She noted that disparities are not linked to biological reasons but rather are the result of social determinants. However, for patients with HS, biological factors like hair follicle biology and propensity for fibrosis play a significant role in the development of the condition. She recommended further study to determine the prevalence of these factors in HS development.

The most significant social determinant-related disparities in HS management, according to Dr. Okoye, are access to health care, particularly dermatologic care; restricted formularies; access to healthy foods and a safe, walkable environment; and mistrust of the medical establishment due to negative experiences with health care providers, such as being told that poor hygiene caused their HS.

Dr. Okoye noted the difficulties in treating HS. Adalimumab is the only US Food and Drug Administration-approved therapy insurance companies offer for patients with HS. There are no discount programs for individuals with public insurance, and securing prior authorizations and dealing with specialty pharmacies can be time-consuming.

Furthermore, several patient factors, including needle anxiety, long-term side effects, potential infections, cancer risk, lack of efficacy, expense, and refrigeration requirements affect treatment, she said.