Hidradenitis suppurativa (HS), also referred to as acne inversa, is an inflammatory skin condition.
It happens when keratin, sweat, and bacteria build up in hair follicles. This causes inflammation in the follicles and may result in pus-filled abscesses.
The follicles may burst and cause painful lesions. Sometimes abscesses cause tunnels under the skin.
HS is most likely to occur in the armpits, under the breasts, and in the groin area. It’s not entirely understood why this happens, but certain factors — including genetics, smoking, obesity, and hormones — may contribute to HS.
Data demonstrates that HS occurs more frequently in Black people. One reason for this may be inequities in healthcare and in the ability to access care.
It’s essential to have timely and expert care to manage this chronic disease, which isn’t always the case for many Black people.
Among Black people, the number is much higher. For every 100,000 Black people, 296 have HS. The biracial population is estimated to have 218 cases per 100,000 people.
It’s not clear whether genetics explain these higher rates. According to a 2018 review, one study from the 1960s suggested that Black people have more sweat glands. However, there hasn’t been any updated research in this area.
Much of the research on HS has been done in groups that don’t represent the actual population of people living with HS. Black people are under-represented in HS research, even though they have higher rates of HS.
There can be major barriers to accessing care Black, Indigenous, and People of Color (BIPOC).
Black people have lower access to dermatologists. This means they’re less likely to get an accurate diagnosis.
The symptoms of HS in the early stage can be mistaken for other conditions. Without an accurate diagnosis, the right treatments won’t be started.
In the same 2018 review mentioned earlier, researchers noted the high number of Black people with HS who sought emergency care for this condition. This could be from not getting the right treatment in earlier stages of HS.
There are some very troubling beliefs about Black skin, even among health professionals.
HS can be a very painful condition. Managing the pain and inflammation is a critical part of caring for HS. Your pain won’t be managed if a healthcare professional doesn’t believe your pain is real and needs treatment.
For the past 50 years, Black people in the United States have had the lowest median income.
In 2019, 18.8 percent of Black people lived in poverty in the country, according to the Current Population Survey Annual Social and Economic Supplement. The overall poverty rate is 10.5 percent.
People with a lower socioeconomic status have higher rates of HS, according to the aforementioned 2018 review.
Living in poverty makes it much harder to access the healthcare you need. Cost of care or lack of health insurance may represent major challenges. Other barriers include:
- child care
- loss of pay from taking time off work
Depending on the stage of HS, different treatment options are available. HS is a chronic condition, so the treatment is likely to change over time. Ongoing care from expert healthcare professionals is an essential part of getting the right treatments.
Here are some of the treatments that may be used as part of HS management:
- Antibiotics. Topical or oral antibiotics can be used in case of infections. Topical antibiotics have fewer side effects compared with the oral kinds.
- Oral retinoids. This class of medication is often used for the treatment of acne. Sometimes it can be helpful for cases of HS.
- Anti-inflammatories. These are oral medications. Many are available without a prescription. They reduce pain by suppressing inflammation in the body.
- Corticosteroids. Corticosteroids can help lower the immune response. This can reduce the inflammation and pain of HS.
- Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors). These medications can help to reduce the inflammatory immune response. Certain proteins released by the immune system cause inflammation, and these meds block them in order to reduce pain and inflammation.
- Contraceptives. For people who get periods, there may be a pattern to when flares of HS happen. Birth control medications can help modify hormones to prevent flares in some people.
- Carbon dioxide laser treatments. This procedure may be used in more severe cases of HS. Lasers are used to remove sections of skin affected by HS.
- Laser hair removal. Lasers are used to damage the hair follicle and prevent hair growth. This may help to prevent a recurrence of HS in that area. It seems to work best in milder cases of HS.
HS is a chronic inflammatory skin disease. It’s more likely to occur in Black people, although it’s unclear why.
One explanation may be significant barriers to getting the right care. Without the right care, the condition can worsen and affect quality of life.
Black people are less likely to have access to a dermatologist familiar with their skin. This means that HS may be diagnosed at later stages and be harder to treat.
Much more needs to be done to ensure equal access to care for Black people.