INTRODUCTION
Hidradenitis Suppurativa (HS) is a chronic disease that causes inflammatory lesions typically found in the axillary, inguinal, and perineal regions that can result in permanent scarring, fibrosis, and sinus tract formation.1 The disease can result in substantial physical and mental distress. A recent 2021 systematic review and metaanalysis estimated a prevalence of 0.4% in the United States.2,3 Another retrospective analysis of 47,690 HS patients in the U.S. showed a standardized prevalence that was three times higher in Black patients compared to White patients.4 This is a generally accepted breakdown, with most studies finding a disproportionate prevalence of HS in skin of color populations.
Although HS is more prevalent in skin of color populations, research in HS has historically been performed in European and White populations.5 One of the handful of populationbased studies of HS incidence took place in Olmsted County, Minnesota where 90.3% of their study population was White, therefore not reflective of the demographics of HS patients.6 Furthermore, we see that racial subgroups may be at a higher risk for greater disease burden and severity due to higher prevalence of comorbidities including metabolic syndrome, comorbid depression, and low socioeconomic status.7 Studies of racial differences in HS disease pathophysiology suggest that Blacks may have more apocrine glands, more productive apocrine glands, and different pilosebaceous unit anatomy compared to other groups; potentially explaining the increased prevalence seen in Black populations.7 Other studies postulate that patients of color may have increased disease severity and greater healthcare utilization due to lower socioeconomic status, higher prevalence of comorbid conditions, and decreased access to healthcare compared to other groups.5
Despite these observations, there is limited research determining how HS treatments may differentially affect racial and ethnic groups.8 It is well established that Blacks are significantly more affected by HS, yet White patients make-up 68.0% of the patient population included in HS clinical trials while those of African descent comprise only 14.0%.8 About half of recent HS clinical trials took place in the US with most other locations in Europe. The most common countries being Greece, the Netherlands, and Denmark. No trials were done in representative skin of color populations such as Africa or South America.8 Furthermore, no stratifications or sub-group analyses by race were performed despite evidence that there may be differences across race in the pathophysiology of disease and response to treatment. Multiple studies advocate that further exploration of management of HS across racial groups is vital and promote the idea that race as well as ethnic background should be considered by providers
Although HS is more prevalent in skin of color populations, research in HS has historically been performed in European and White populations.5 One of the handful of populationbased studies of HS incidence took place in Olmsted County, Minnesota where 90.3% of their study population was White, therefore not reflective of the demographics of HS patients.6 Furthermore, we see that racial subgroups may be at a higher risk for greater disease burden and severity due to higher prevalence of comorbidities including metabolic syndrome, comorbid depression, and low socioeconomic status.7 Studies of racial differences in HS disease pathophysiology suggest that Blacks may have more apocrine glands, more productive apocrine glands, and different pilosebaceous unit anatomy compared to other groups; potentially explaining the increased prevalence seen in Black populations.7 Other studies postulate that patients of color may have increased disease severity and greater healthcare utilization due to lower socioeconomic status, higher prevalence of comorbid conditions, and decreased access to healthcare compared to other groups.5
Despite these observations, there is limited research determining how HS treatments may differentially affect racial and ethnic groups.8 It is well established that Blacks are significantly more affected by HS, yet White patients make-up 68.0% of the patient population included in HS clinical trials while those of African descent comprise only 14.0%.8 About half of recent HS clinical trials took place in the US with most other locations in Europe. The most common countries being Greece, the Netherlands, and Denmark. No trials were done in representative skin of color populations such as Africa or South America.8 Furthermore, no stratifications or sub-group analyses by race were performed despite evidence that there may be differences across race in the pathophysiology of disease and response to treatment. Multiple studies advocate that further exploration of management of HS across racial groups is vital and promote the idea that race as well as ethnic background should be considered by providers
