Barriers to Dermatologic Care and Use of Internet Sources in Hidradenitis Suppurativa

Although hidradenitis suppurativa (HS) often requires multidisciplinary care, dermatologists specialize in the diagnosis and management of this condition. As HS is associated with low socioeconomic status, individuals may face barriers accessing dermatologic care due to financial and insurance challenges.^1,2 A qualitative study of HS participants noted that frustrations with delays in care may drive patients to use the Internet to learn about HS.³ This study further evaluates barriers to dermatologic care and the use of internet sources amongst those with HS.

An anonymous, 40-item, multiple-choice survey was distributed in HS-related online groups. Participants 18 years and older in the United States with a diagnosis of HS were included. Data were collected between August and September 2022 and analyzed with Microsoft Excel version 16.65. Chi-square tests were performed. The Northwestern University Institutional Review Board approved this study.

Overall, 302 participants completed the survey. Table 1 shows the characteristics of the respondents. Regarding the primary medical providers for management of their HS, 69.9% (211/302) reported seeing a dermatologist, 20.5% (62/302) reported seeing a non-dermatology provider, and 9.6% (29/302) reported not seeing any medical provider for their HS. Of those with a non-dermatology provider for their HS, 64.5% (40/62) reported seeing a primary care provider, 21.0% (13/62) reported seeing a surgeon, and 14.5% (9/62) reported seeing a gynecologist. Thirty-nine percent (82/211) of those with a dermatologist visited them yearly or less often. Over half of all respondents (51.3%, 155/302) reported that seeing the dermatologist is difficult or very difficult. Black (odds ratio [OR], 2.09; 95% CI, 1.20–3.66; P<0.01) and Medicaid-insured individuals (OR, 2.64; 95% CI, 1.44–4.85; P<0.01) were more likely to report difficulty than those who were White or had private insurance, respectively. Commonly reported barriers to seeing the dermatologist include long wait times to schedule appointments (59.6%, 180/302), financial/insurance challenges (24.2%, 73/302), HS-related pain hindering appointment attendance (23.8%, 72/302), work-related challenges (18.9%, 57/302), commute/transportation challenges (13.9%, 42/302), and inability to obtain referrals (7.3%, 22/302).