HS prevalence, severity higher among Black patients
Data points to a need for earlier hidradenitis suppurativa diagnosis and treatment, but more studies needed (Issue #231, 1,400 words, 7 minutes)
There is a shortage of studies regarding the race-specific prevalence of hidradenitis suppurativa (HS). However, because the disease may be more severe in patients with darker skin types, physicians need to diagnose and treat early.
These messages were part of a presentation by Dr. Marissa Joseph at the Great Lakes Immunodermatology Exchange (GLIDE) 6.0 meeting on Nov. 2, 2024, in Niagara-on-the-Lake, Ont. Dr. Joseph is the Medical Director of the Ricky Kanee Schachter Dermatology Centre at Women's College Hospital in Toronto.
“When we look at race-specific prevalence of HS, there have only been a few studies,” Dr. Joseph said. The studies that have been done show there is an over-representation of HS in racialized patients, particularly Black patients, she said.
She said that it is similar to clinical trials on HS treatments. “None of the trials included sub-analysis of treatment efficacy based on race or ethnicity.”
She said the lack of sub-analysis is due in part to the low enrollment of racialized and ethnic patients in many clinical trials, which results in participant numbers too low to perform statistically valuable sub-analyses.
“In terms of the severity of HS and African ancestry, there appears to be increased severity, and that's associated with lower socioeconomic status,” Dr. Joseph said. “More patients with African ancestry have Hurley stage three [HS] than non-African ancestry [patients], and patients with HS who are Black demonstrated a lower mean socioeconomic status.”
Dr. Joseph noted these findings come from U.S. data: “I often say when people start to talk to me about African American data, it's clear that the bio-ancestral background of patients in the United States might differ from Canada.”
Another study examined skin diversity and patients who are hospitalized with HS and found a trend toward a disproportionate burden of hospitalization among patients who are African American with HS.
Black patients in her practice come from across the African diaspora, including some first-generation Canadian patients who have immigrated from Africa or the Caribbean.
There is a tendency to lump all patients with a particular skin tone together, but “we have to dissect out these different groups,” she said.
Dr. Joseph said that because of the scarring sequelae of HS, including hypertrophic scars and keloids, it is essential to establish the diagnosis of HS as early as possible.
Bottom line: There is limited study data on the prevalence of HS among different racial and ethnic groups. What data there is suggests a greater prevalence and more severe disease at diagnosis among Black patients. Because of the elevated risk of scarring sequelae from HS in darker skin, physicians need to work to diagnose HS sooner in all patients.
From the literature on hidradenitis suppurativa in skin of colour
Association between skin-related quality of life and race in patients with moderate-to-severe hidradenitis suppurativa: Analysis of two phase 3 clinical trials
This study compares skin-related quality of life (QoL) between Black and White patients with moderate-to-severe hidradenitis suppurativa (HS).
To do this, they analyzed pooled, deidentified data from the PIONEER I and II phase 3 trials of adalimumab for HS.
Investigators compared the mean baseline Dermatology Life Quality Index (DLQI) scores between Black and White patients while adjusting for age, sex, smoking status, baseline abscess/nodule (AN), and draining fistula count. In a secondary analysis, they compared changes in DLQI from baseline to week 12 follow-up between Black and White Hidradenitis Suppurativa Clinical Response (HiSCR) responders.
They found Black patients with moderate-to-severe HS experienced somewhat lower skin-related QoL at baseline when compared with White patients with similar disease severity in the PIONEER trials. This was a difference of 3.5 (95% CI, 1.3-5.8) in PIONEER I and 1.9 (95% CI, −1.8 to 5.6) in PIONEER II. The authors note that a difference of 4 represents the minimal clinically important DLQI difference. However, potential HS-specific factors not captured by DLQI may contribute to race-related differences in QoL among patients with HS. The degree of QoL improvement among HiSCR-responders was similar for Black and White patients.
Exploring racial and ethnic disparities in the hidradenitis suppurativa patient disease journey: Results from a real-world study in Europe and the USA
This study assessed the impact of race and ethnicity on hidradenitis suppurativa (HS) diagnosis and management in real-world clinical settings. Researchers derived data from the Adelphi Real World Hidradenitis Suppurativa Disease Specific Programme, a survey of dermatologists and their consulting HS patients in five European countries and the U.S. in 2020 and 2021.
Data on 1,787 patients was assessed in total. Of those, 57.6% were female, and 77.7% were White.
The authors found people from racial and ethnic minority groups were younger than White patients (32.9±11.6 vs. 34.9±12.4 years, mean standard deviation) and reported symptoms at a younger age (23.3±10.8 vs. 26.2±11.1). Still, their time to first consultation was longer than for White patients (2.6±5.7 vs. 1.2±2.5 years).
People from racial and ethnic minority groups took longer to receive a correct diagnosis following the first consultation (2.7±5.3 vs. 1.5±4.1 years) and were more likely to be misdiagnosed with boils (73.5% vs. 40.4%). People from racial and ethnic minority groups had a greater disease awareness at diagnosis and reported wanting more significant support. People from racial and ethnic minority groups also reported a greater impact on life, more severe pain, and a greater level of activity impairment in the Work Productivity and Activity Impairment: General Health (27.0±25.2 vs. 20.0±20.6). All p values were ≤0.05.
Patient-perceived physician bias in hidradenitis suppurativa (HS)
In this paper, investigators explore race and ethnicity's role in hidradenitis suppurativa (HS) patients' perceptions of physician bias and the quality of their care.
The researchers administered a cross-sectional anonymous online survey to individuals with HS from June 13 to 30, 2021. They employed items from the Commonwealth Fund 2001 Health Care Quality Survey to evaluate whether participants felt judged based on race or ethnicity.
The survey received 1,040 responses from six continents, with the cohort being mostly female and racially and ethnically diverse. The majority of the cohort was female and racially and ethnically diverse. Overall, 15.2% (136/894) of respondents reported feeling they would receive better care if they were of a different race or ethnicity, and 13.6% (122/894) felt their primary HS provider treated them unfairly based on race.
Participants who belonged to minority groups more often reported feeling that they would receive better medical care if they were of a different race or ethnicity and thought that they were maltreated due to their race or ethnicity compared to White participants.
VIDEO: 2024 new therapies in hidradenitis suppurativa
Barry I. Resnik, MD, Medical Director of the Resnik Skin Institute in Aventura, Fla., reviews the pathology of HS and then discusses current and emerging treatments for the disease.
At the intersection of skin and society
On Jan. 13, Nova Scotia MP (Sydney-Victoria) Jaime Battiste announced his intention to become the leader of the Liberal Party of Canada and the country’s first Indigenous prime minister.
Battiste, who is Mi’kmaw, was first elected in 2019.
In a statement on Facebook, Battiste said he had received much encouragement to run for the party’s leadership from Indigenous leaders and other Canadians. “I’ve heard your voice, and with your help, I’m interested,” he said.
“I am laying the groundwork for an exploratory team that will seek to launch the first campaign by an Indigenous candidate for the leadership of the Liberal Party of Canada and to be the next Prime Minister of Canada.”
Battiste was the first Mi’kmaw person elected to the House of Commons and has served as chair of the Liberal Indigenous caucus for the past several years.
The party has set the entrance fee for leadership candidates at $350,000, which could be paid in installments. Officials have not announced the specific dates when the cash will be due, but spokesman Parker Lund said a committee would determine it.
Battiste said in his statement that he understands the challenges facing him in entering the leadership race.
“I am fully aware of the complexity of raising $350,000 over the next 12 days.”
This week
January is Tamil Heritage Month in Canada
Jan. 20 is International Day of Acceptance
Jan. 26 is World Leprosy Day 2025
Something to think about in the week ahead . . .
—Victor Hugo, French author (1802–1885)
Next week
In a presentation at the 4th annual Indigenous Skin Spectrum Summit, Ottawa-based dermatologist Dr. Reetesh Bose described how an initiative by Ottawa dermatologists is supporting skin health for Indigenous patients in Iqaluit.
Register now for the first Global Indigenous Skin Spectrum Summit in Montreal
Happy New Year to the readers of Skin Spectrum Weekly. The first Indigenous Skin Spectrum Global Summit will be held in Montreal on April 5, 2025, and it is only a few short months away.
We invite you to attend the summit to consider the unique dermatologic challenges facing Indigenous populations worldwide. It is an opportunity to learn from experts on how physicians can support equitable health for these populations.
Summit chair Dr. Rachel Asiniwasis (Regina) leads a world-renowned faculty that includes Dr. Rachel Pugh (Australia), Dr. Carsten Sauer Mikkelson (Denmark), Dr. Monique Mackenzie (New Zealand), Dr. Anna Chacon (Florida), Dr. Dana Slape (Australia), Dr. Carolyn Jack (Montreal), and other thought leaders.
More details on the Global Summit will appear in future editions of Skin Spectrum Weekly.
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