Hidradenitis suppurativa more common, often more severe in skin of colour
Hidradenitis suppurativa more common, often more severe in skin of colour
Social factors that contribute to obesity or lack of medical access may be contributing factors, but there is a shortage of relevant research (1,090 words, 5 minutes 30 seconds)
Hidradenitis suppurativa (HS) appears to be more common in populations of skin of colour, and its impact on quality of life in these groups seems to be made worse by socioeconomic factors, Dr. Afsaneh Alavi explained during a talk at the 7th annual Skin Spectrum Summit on Nov. 4.
However, she said there is a lack of research comparing HS pathology and outcomes between skin types that could inform care.
Dr. Alavi is a dermatologist and the medical lead for dermatology clinical trials at the Mayo Clinic's campus in Rochester, Minn. She has a clinical interest in chronic wounds, focusing on inflammatory wounds and skin manifestations of gastrointestinal disorders.
“The prevalence of HS is estimated to be up to 4 per cent globally, and it is three times higher in people of African descent compared to the white population,” Dr. Alavi said. She also noted Black patients with HS are more likely to have comorbidities and have more outpatient clinic visits than white patients. There is literature indicating that HS is also less common in Asian and Hispanic populations than in white populations.
Some research has shown that HS frequency is associated with lower socioeconomic status, Dr. Alavi noted. “And racial differences in socioeconomic status is closely linked to racial disparities in health and psychological well being.”
Dr. Alavi described several differences in HS between racial populations as well as some unanswered questions:
One study shows more severe HS in African American patients—more cases presenting at Hurley stage two or three
In patients of African descent, some HS morphologies are more common, including scarring, keloid formation, and dissecting cellulitis of the scalp
In Asia and South Asia, HS is most frequently seen in men, compared to Western countries where the condition is most frequently seen in women
Half of HS cases in Asia and South Asia have buttock involvement, which is much less common in Western nations
There are a lack of studies comparing the response to treatment between various skin types
There are a lack of studies investigating whether differences in hair follicles and apocrine glands between skin types impact HS presentation
Bottom line:
Dr. Alavi said that despite the recent momentum of the skin of colour conversation in dermatology, adequate research on HS in skin of colour is lacking. Minority communities are underrepresented in clinical trials. She said that dermatologists who manage HS patients with skin of colour should increase surveillance for specific comorbidities, such as metabolic syndrome, and encourage lifestyle modification. Physicians should increase evaluation of the severity of depression in these patients, consider more genetic testing and encourage clinical trial enrollment.
From the literature on HS in skin of colour
Hidradenitis suppurativa in skin of colour
This article is an overview of the 10th European Hidradenitis Suppurativa Foundation Conference. It includes a summary of the epidemiology, pathogenesis, clinical picture of HS focusing on treatment options from southeast Asia and Africa. The authors have general recommendations for the diagnosis of HS that they say should lead to better clinical care and outcomes among diverse patient populations.
Hidradenitis suppurativa in patients of colour is associated with increased disease severity and healthcare utilization: A retrospective analysis of two U.S. cohorts
A retrospective analysis was conducted on HS patients comparing demographics, disease severity, and healthcare utilization among adults identified to have had at least two encounters with the system coded for HS. This included 939 patients seen at Stanford Hospital in Stanford, Calif. and 13,885 records taken from a U.S. national dataset.
Investigators found that Black and Hispanic patients had greater healthcare utilization than White patients, and Hispanic patients at Stanford had significantly greater disease severity than their white counterparts.
Assessment of the generalizability of hidradenitis suppurativa microbiome studies: The minimal inclusion of racial and ethnic populations
This letter notes that the current literature suggests that microbial dysbiosis contributes to the pathogenesis of HS. The authors review existing HS microbiome studies to characterize the demographics of the subjects in those studies and evaluate the generalizability of current research and microbiome-altering therapeutics.
Clinical trials and skin of colour: The example of hidradenitis suppurativa
The authors of this paper note that even though HS is more common among African Americans, this population is minimally included in HS clinical trials. This publication explores the lack of African American representation in these studies by examining the clinical trial locations within the U.S. The investigators also discuss potential barriers to African American inclusion in these trials.
VIDEO: Hidradenitis Suppurativa, Compassionate Care for JayJay
This recording is documentary footage of Dr. John Gilmore working in his clinic in the Houston, Texas area, providing care to a Black patient with axillary HS lesions (click image below to view.)
At the intersection of skin and society
“Blackity” is an exhibition that examines the trajectory of contemporary Black Canadian art, working from the collection of Artexte between the 1970s and the 2010s. Artexte is a library, research centre and exhibition space for contemporary art in the Quartier des spectacles in Montreal.
According to a press release from Artexte, there is a history of Black Canadian artistic practices being cyclically forgotten.
The release explains that “Blackity” gathers some key moments and people to consider the thematic, aesthetic or conceptual threads linking them. By placing these documents in relation to one another, curator Joana Joachim creates a temporal map of Black Canadian art in history.
“The vertical bands seen throughout the exhibition are a visualization of data pulled from e-Artexte. The upward motion of the disconnected stripes emphasizes the fragmentary nature of this history echoing the trends around documenting Black Canadian art practices. Thinner bands represent a small number of documents during a certain time period in the collection whereas thicker ones represent an abundance of information. The digital exhibition includes audio clips from the curator as well as short notes and expanded annotations nodding to various people, projects, documents and videos from outside the Artexte collection.”
--Joana Joachim, in the introduction to the accompanying pamphlet to “Blackity”
In addition to being presented on-site at Artexte until Mar. 26, 2022, “Blackity” is also being exhibited online at www.artexte.art
This week
Nov. 29 to Dec. 5 is Digital Health Week in Canada
Dec. 2 is International Day for the Abolition of Slavery
Dec. 3 is International Day of Persons With Disabilities
Something to think about in the week ahead…
Next week
In a talk at the 7th annual Skin Spectrum Summit on Nov. 4, Dr. Yvette Miller-Monthrope discussed the epidemiology of psoriasis in different skin types. She also described specific psoriasis treatment considerations in patients with Black skin.