Hidradenitis suppurativa (HS) disproportionately affects Black patients, who may experience more severe disease, longer diagnostic delays, and greater healthcare utilization, according to Julia M. Riley, MD, of Northwestern University Feinberg School of Medicine in Chicago.
In this exclusive MedPage Today video, Riley discusses key takeaways from her presentation at the European Academy of Dermatology and Venereology meeting in Vienna, including recognizing inflammation and pigment changes in skin of color, addressing barriers that can delay diagnosis and treatment, and managing the increased risk of keloids.
Following is a transcript of her remarks:
I started by discussing disparities in HS. So, in the U.S., we know that there’s a threefold higher prevalence of HS, specifically in Black patients, with data indicating that patients with HS have more severe disease, they have longer diagnostic delay, they also have increased healthcare utilization.
I also discussed principles of treating HS in skin of color and in pigmented skin, so topics like recognizing inflammation in skin of color, understanding the post-inflammatory pigment alterations that can occur, and also using those as a clue to assessing disease severity. I also talked about keloids in HS and discussed that overlap.
And then finally, I talked about principles for how to address barriers to care and specifically dove into biologic hesitancy, which can be an issue that a lot of our patients are concerned about.
There’s many causes of this delay. It’s multifactorial. So there’s difficulties in patients accessing care, which is more of a system-wide level. So that could be insurance barriers, it could be long waits for dermatology visits.
That’s a patient who really needs to be seen sooner for their first initial appointment, and then providing them with access to us, whether it’s MyChart or a messaging system where they can quickly reach us if they need for disease flares. Because we know that this disease is sort of characterized by chronic disease, but also flares where they’re having worsening pain, drainage, and it can significantly impair their quality of life.
Patients with hidradenitis are also at an increased risk of developing keloids, and we often see this in two different settings. So, one is at the lesion of the HS itself. This can be in response to the inflammation. Patients can develop a keloid at the site, but the other is after surgical procedures. So, for example, if a patient has a de-roofing performed from HS, it is possible that they may develop a keloid at that site.
In the former situation, it’s really important to be treating those patients aggressively, whether that’s with biologic medications to prevent the formation of additional keloids. In the second situation where a keloid is forming after a procedure, it’s very important to counsel patients on the fact that this may occur if they are someone who’s had a history of keloids or who’s predisposed to keloids, but it also can be treated.
So, we often use intralesional steroid injections to help with symptoms that are associated with keloids or to actually flatten out those lesions. And in most cases, I find that patients, even if they do develop keloids after an HS excision, prefer the keloid scar to the HS lesion that was present before the surgery.
