Hidradenitis suppurativa (HS), also referred to as acne inversa, is an inflammatory skin condition.

It occurs when keratin, sweat, and bacteria build up in hair follicles. This causes inflammation in the follicles and may result in pus-filled abscesses.

The follicles may burst and cause painful lesions. Sometimes, abscesses cause tunnels under the skin.

HS is most likely to occur in the armpits, under the breasts, and in the groin area. It’s not entirely understood why this happens, but certain factors — including genetics, smoking, obesity, and hormones — may contribute to HS.

Data demonstrates that HS occurs more frequently in Black people. One reason for this may be inequities in healthcare and the ability to access care.

It’s essential to have timely and expert care to manage this chronic disease, which isn’t always the case for many Black people.

A 2017 analysis explored the rates of HS in the United States. It estimates that for every 100,000 people, there are 98 cases of HS in the general population.

However, among Black people, the number is much higher. For every 100,000 Black individuals, 296 have HS, while the biracial population is estimated to have 218 cases per 100,000 people.

It’s unclear whether genetics explain these higher rates. Some research suggests that Black people have more and larger sweat glands compared to other races. However, there hasn’t been much research in this area.

Much of the studies on HS have been conducted in groups that don’t represent the actual population of people living with HS. Black people are under-represented in HS research, even though they have higher rates of HS.

There can be major barriers to accessing care for Black, Indigenous, and people of color.

Black people have lower access to dermatologists. This means they’re less likely to get an accurate diagnosis.

The symptoms of HS in the early stage can be mistaken for other conditions. They can also appear differently in darker skin tones compared to lighter skin. However, without an accurate diagnosis, the right treatments won’t be started.

Some research has also noted the high number of Black people with HS who sought emergency care for this condition. This could be from not getting the right treatment in earlier stages of HS.

There are some very troubling beliefs about Black skin, even among health professionals.

One 2016 study looked at how racial biases affect the care of Black people. Black individuals are less likely to be given pain medications — and even when they do receive them, they get less treatment for pain compared with white people.

HS can be a very painful condition. Managing the pain and inflammation is a critical part of caring for HS. Your pain won’t be managed if a healthcare professional doesn’t believe your pain is real and needs treatment.

For the past 50 years, Black people in the United States have had the lowest median income.

In 2022, 17.1% of Black people lived in poverty in the country — a record low, according to the Current Population Survey Annual Social and Economic Supplement. The overall poverty rate is 11.5%.

People with a lower socioeconomic status also tend to have higher rates of HS.

Living in poverty makes it much harder to access the healthcare you need. Costs of care or a lack of health insurance may represent major challenges. Other barriers include:

  • transportation
  • child care
  • loss of pay from taking time off work

Depending on the stage of HS, different treatment options are available. HS is a chronic condition, so the treatment is likely to change over time. Ongoing care from expert healthcare professionals is an essential part of getting the right treatments.

Here are some of the treatments that may be used as part of HS management:

  • Antibiotics: Topical or oral antibiotics can be used in case of infections. Topical antibiotics have fewer side effects compared with the oral kinds.
  • Botulinum toxin injections (Botox): This helps treat excessive sweating, which may help reduce the number of HS lesions in certain areas.
  • Oral retinoids: This class of medication is often used to treat acne. It can sometimes be helpful for cases of HS.
  • Anti-inflammatories: These are oral medications, and many are available without a prescription. They reduce pain by suppressing inflammation in the body.
  • Corticosteroids: These can help lower the immune response, reducing the inflammation and pain relating to HS.
  • Biologic drugs: These medications can help reduce the inflammatory immune response. Certain proteins released by the immune system cause inflammation, and these medications block them to reduce pain and inflammation.
  • Contraceptives: For people who get periods, there may be a pattern to when flares of HS occur. Birth control medications can help modify hormones to prevent flares in some individuals.
  • Carbon dioxide laser treatments: This procedure may be used in more severe cases of HS. Lasers are used to remove sections of skin affected by HS.
  • Laser hair removal: This uses lasers to damage the hair follicle and prevent hair growth. This may help prevent a recurrence of HS in that area. It seems to work best in milder cases of HS.
  • Spironolactone: While not a first-line treatment, this drug can be used to treat mild to moderate forms of HS in women of childbearing age due to its anti-androgenic effects.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. It’s more likely to occur in Black people, although it’s unclear why.

One explanation may be significant barriers to getting the right care. Without the right care, the condition can worsen and affect quality of life.

Black people are less likely to have access to a dermatologist familiar with their skin. This means that HS may be diagnosed at later stages and be harder to treat.

Much more needs to be done to ensure equal access to care for Black people.