Why Blacks are Diagnosed with HS Much Later

Without early or accurate diagnosis of any condition, proper care and treatment plans are prolonged. Studies show that Blacks have lower access to dermatologists and quality healthcare providers. In return, Blacks are discovering they have hidradenitis suppurativa much later than they should.

Hidradenitis suppurativa (HS) is a chronic skin condition that causes long-term inflammation of the skin. It’s a mild to severe condition that results in lesions underneath the skin. These lesions can also grow into abscesses (pockets of pus). It’s most common to see HS where the skin rubs together or in skin folds, such as under the breast, the groin, armpits, and buttocks.

Black people are three times more likely to develop HS, and tend to have more severe experiences with HS than any other race. This could be attributed to genetic factors, environmental factors and behavioral factors.

Such as:

Obesity/heavier body weight results in extra rubbing and friction of the skin, more sweating and moisture that gets trapped in the skin, and more overlapping / skin-fold surface area.
Family health history /specific genes increase the chance of developing HS.
Smoking cigarettes is a risk factor and HS symptoms tend to be more severe in Black people who smoke cigarettes.

Symptoms of HS as it pertains to Blacks:

Boil-like lumps (can range from pea-sized to marble-sized)
Tunnels/channels in the skin that leak blood or pus
Leaking bumps or sores
Blackheads(they appear in small, pitted areas of the skin)
Intense pain on or around the affected area
Scarring
Swelling

Also common:

Body odor
Excess sweating
Itching

Visually, you can expect:

Flesh-colored, purple or dark nodules(small firm lumps)

So, knowing that Black people are three times more likely to develop HS, you would think that Black people are getting diagnosed and treated for HS more often, right? The unfortunate reality is, that Black people tend to go longer without a diagnosis or treatment. How so? I believe racial disparities play a huge factor.

Black people have a lack of access to quality care/healthcare physicians, there is a lack of research on how HS affects Black people, and we are underrepresented in clinical trials and healthcare settings overall. This directly affects how we are cared for, early on and during complications. Early diagnosis and treatment plans are super critical for the care and management of HS.

A dermatologist or healthcare provider who specializes in skin care should thoroughly address your concerns and take all symptoms, medical history, and exams into consideration when diagnosing HS. From there, HS can be classified into one of three stages.

Stage 1, mild. Typically occurs with one (or several) nodules. These nodules may develop into abscesses. There are no sinus tracts or tunnel formation.
Stage 2, moderate. During this stage, there may be recurring episodes of nodules and abscesses that may be spread apart. Commonly they are connected with a tunnel or sinus tract between the affected areas.
Stage 3, severe. Extreme recurring abscesses and sinus tunnels on an entire area.

For early diagnosis and to receive effective medical treatment, it’s best to seek a healthcare provider about your condition when flare-ups are often, it’s super painful in key areas, appears in several locations, and when it’s difficult to move around normally.

Although there is no cure for HS, there are many ways to manage and treat it, here's how:

Antibiotic cream/ointment will help reduce infection and bacteria in the affected area
Resorcinol cream helps reduce inflammation by opening up clogged hair follicles
Oral medications will help to decrease bacteria, infection and inflammation
Hormonal therapy may be effective for mild HS and decreasing symptoms
Steroid injections helps to decrease inflammation
Laser therapy can be used to make any sores go away
Surgical removal involves removing all the affected skin
Punch debridement/unroofing is a procedure that removes a single inflamed bump

These tips may relieve discomfort:

Apply a warm compress on the affected area
Quit smoking
Stay active / maintain a healthy weight
Thoroughly and gently wash your body(antiseptic wash is recommended)
Avoid using loofahs, washcloths or towels that will irritate the affected area
Don't pop, squeeze or scratch your sores, pimples and lumps
Be mindful of what you eat and drink

Being educated about HS will help you seek proper care, advocate for yourself and learn to better care for yourself. This overall will improve your quality of life.