Hidradenitis Suppurativa on Darker Skin

Symptoms, awareness, and treatment

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Hidradenitis suppurativa (HS) is often misunderstood, misdiagnosed, or not addressed at all, especially in people with darker skin tones. Without a timely and accurate diagnosis, people with HS may not be properly treated, impacting treatment effectiveness and quality of life.

Read on to learn more about hidradenitis suppurativa, the chronic skin condition, and how it affects darker skin.

Skin Health Divide: hidradenitis suppurativa

Zoe Hansen / Verywell Health

Symptoms and Presentation

HS is characterized by chronic, recurrent skin lesions on the armpits, under the breasts, around the groin, and between the buttocks.

Lesions may spontaneously rupture and have a smelly discharge. They can cause pain and deep sores and affect the ability to walk, especially when located in the lower part of the body. In severe cases, scarring can occur.

Research shows that HS presents differently between racial groups, in that people with darker skin tend to have a more severe disease burden than people with fair skin.

HS is also more prevalent in people with skin of color. The number, size, and productivity of sweat glands in people with darker skin tones might explain why HS occurs more frequently and is more severe in Black Americans.

Hidradenitis suppurativa in people of color is often misdiagnosed as other conditions that cause lesions and boils. These delays in diagnosis can lead to HS progression, scarring, disability, and disease co-morbidities. Further, there are vast differences in melanin expressions that are often lumped together in a manner that prioritizes treating lighter skin tones.

Lack of Representation in Clinical Studies

Most studies of HS have been done on large populations of people with light skin, or without consideration of skin tone at all.

Diagnostic Challenges

Diagnosing HS involves a skin examination to check for lumps, sores, or drainage. They will also take a medical history and ask about a family history of skin disease.

There are no laboratory tests to diagnose HS. However, if pus or drainage is present, a healthcare provider will send a sample of the drainage to a laboratory for testing. This is done to rule out other conditions, specifically infections.

People with HS who have darker skin are often misdiagnosed, and many go years without access to specialists. Because they go so long without an accurate diagnosis, they don’t receive the early treatment they need to reduce the burden of HS.

Because of the way the condition presents (with abscesses, drainage, foul odor, and scarring), and where it presents (under the armpits, the groin, buttocks, etc.), people with the condition might be embarrassed to discuss it with their healthcare providers. 

HS diagnosis and treatment may also be delayed due to mistrust in the healthcare system, especially from people of color who have experienced medical bias or trauma.

By providing outreach and support in communities of color, it is possible for more people in these groups to receive accurate diagnoses and to have access to early and appropriate treatments that may reduce disease severity and burden.

Quality of Life and Effects of HS

HS is known for having significant physical and psychological effects. It can cause embarrassment and lead to social isolation and disability. It also affects personal relationships and sexual intimacy. 

The long-term burden of HS can cause reduced quality of life, depression, and anxiety, particularly for people with severe disease. Some factors that contribute to the increased risk of depression in Black and Hispanic people with HS include functional limitations, lack of health insurance, and lack of physical activity.

Treatment and Skin Color

Treatment for hidradenitis suppurativa involves medications and surgery to control symptoms and reduce the potential for complications. Patients should talk to a healthcare provider about the risk and benefits of all treatment options and develop a treatment plan based on their unique case.

Some treatment options for HS include:

  • Antibiotic creams for treating mild skin symptoms
  • Pain medications (both over-the-counter pain relievers and stronger prescription drugs)

Systemic drugs, like Humira (adalimumab), can be prescribed for widespread skin symptoms. Humira is the only approved systemic drug for HS. It is prescribed for moderate-to-severe disease. While studies show it can be helpful in reducing symptoms, they do not show treatment outcome differences for race or skin tone.

Some surgical options may include:

  • Uncover tunnels to remove tissue and expose tunnels under the skin
  • Laser therapy to clear and remove new breakouts
  • Drain abscesses to provide pain relief
  • Excision (cutting out) of lesions and scar tissue (skin grafts are then done to replace lost skin)

People with HS will also need regular follow-ups with a dermatologist and potentially additional specialists to treat any co-occurring conditions like depression and joint disease.

Healthcare providers should personalize treatment plans for skin type or color because some treatments may affect darker skin more harshly.

Cost of Care

Cost can be another barrier to care for many people. Certain treatment options may not be affordable or covered by insurance. If you have an insurance carrier, check to see if your medication will be covered by your plan. If you do not have health insurance, discuss other low-cost options with your healthcare provider.

Summary

Hidradenitis suppurativa is a chronic skin condition that causes lumps and sores under the skin. It is more common in people with skin of color, who also experience more severe disease. It can be more challenging to diagnose in these populations as well, causing delayed treatment. HS can reduce a person's quality of life due to potential embarrassment and isolation.

A Word From Verywell

Hidradenitis suppurativa can seriously impact a person's quality of life and self-esteem. If you are struggling with your case of HS, don't hesitate to discuss your concerns with your healthcare provider or a mental health professional. Consider also reaching out to other people living with HS by joining a support group or finding communities on social media.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Wang SC, Wang SC, Alavi A, Alhusayen R, Bashash M, Sibbald RG. Hidradenitis suppurativa: a frequently missed diagnosis, part 2 treatment optionsAdvances in Skin & Wound Care. 2015;28(8):372-380. doi:10.1097/01.ASW.0000466712.21948.8a

  3. Price KN, Hsiao JL, Shi V. Race and ethnicity gaps in global hidradenitis suppurativa clinical trials. Dermatology. 2021;237(1):97-102. doi:10.1159/000504911

  4. American Academy of Dermatology Association. Hidradenitis suppurativa: diagnosis and treatment.

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By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.