What’s more, Black people are more than twice as likely to develop HS as white people. According to a review published in the November 2019 edition of the journal American Family Physician, HS affects 30.6 per 100,000 Black people versus 11.7 per 100,000 white people. Yet Black people often don’t receive necessary HS care and are underrepresented in clinical trials for the condition. “I can’t overemphasize the significant physical and psychological impact of this disease and how it affects quality of life — the ability to have friendships, sexual relationships, and careers that thrive,” says Olayemi Sokumbi, MD, a dermatologist at Mayo Clinic in Jacksonville, Florida. The physical effects of the disease often lead to mental and emotional issues, such as depression and anxiety. In practical terms, this means any Black person who has HS — or suspects they do — is likely to be up against unique challenges when dealing with it. If you’re one of those people, the best strategy is to educate yourself about the condition, find a dermatologist experienced in treating Black patients, and learn which medical and self-care options are available, so you can advocate for yourself and get the best care possible.
HS in the Black Community
Why are Black people so susceptible to HS? For one thing, the condition has a strong genetic component, so there may be genetic variants in Black Americans that lead to a higher prevalence, says Anthony Fernandez, MD, PhD, a dermatologist at Cleveland Clinic in Ohio. Because HS forms in hair follicles (as well as apocrine glands, which secrete a type of sweat), the anatomy of those follicles may come into play as well. “Hair follicles produce keratin, the main protein in hair. In patients with HS, keratin gets stuck within the hair follicle, plugging it,” Dr. Fernandez says. “Caucasian individuals and African Americans have inherently different hair, so the different biology of the hair follicle could be the cause.” Disparities in care may be involved, too. “Some of the difference in prevalence has been attributed to limited access to medical care,” says Jasmine O. Obioha, MD, a dermatologist at Cedars-Sinai in Los Angeles. What’s more, most doctors simply aren’t trained to treat Black Americans’ skin. Finally, many of the comorbidities for HS, such as obesity, are more common in Black people than in white people, adds Dr. Sokumbi.
How HS Is Treated in Black People
Treatment strategies for HS are basically the same for Black and white people, but that may change with further research, says Sokumbi. “Clinical trials have mostly been done on Caucasian patients,” she explains, “so there’s a significant need for research on HS in Black patients to come up with therapies targeted to them.” Meanwhile, for anyone managing HS, it’s a matter of merging medical treatment with self-care.
Medical Treatments
Medical strategies that may be used to treat HS include:
AntibioticsCorticosteroids, such as prednisone, which can have serious side effects if used for long periods of time. Sometimes, a doctor will inject these in a simple office procedure.Immune system suppressants, such as cyclosporine, a drug that’s often prescribed for transplant patientsOral retinoids, which affect the biology of the skinAntiandrogens, which block testosterone, because hormonal shifts sometimes trigger HS
One biologic drug has been approved by the U.S. Food and Drug Administration (FDA) specifically for treating HS and another is sometimes prescribed off-label for this purpose as well. It’s important to note biologics are strong medications and may not be right for everyone. Depending on how severe your HS is, your doctor may recommend you try other options first. Some HS lesions can be surgically “deroofed” — a procedure in which the skin covering a lesion or cluster of lesions is removed, so the lesions can be treated. A more aggressive procedure, for HS that has progressed to a later stage, is called wide excision. It involves removing a specific area of affected glands, as well as a relatively wide margin of healthy tissue surrounding it.
Self-Care
While your dermatologist provides vital insight for guiding your HS treatment, there’s more you can take into your own hands to help gain control of HS. Here are some important strategies to try.
Steer Clear of triggers
Certain factors can trigger HS flares, so learning what they are and taking measures to avoid them is key. Common HS triggers include:
HeatSweatPhysical exertionSkin-on-skin frictionStressSmoking
Besides avoiding triggers, making these lifestyle changes may also help prevent and ease HS symptoms:
Reach and maintain a healthy weight.Quit smoking.Get good quality sleep.Eat a healthy diet.
In particular, Fernandez recommends an anti-inflammatory diet, which has been shown to be helpful for minimizing the severity of a number of chronic inflammatory diseases. Anti-inflammatory foods include fresh fruit, leafy greens, and even coffee and dark chocolate.
Practice good hygiene
A common myth about HS is that it’s caused by “not being clean,” Sokumbi says. Although that’s not true, some personal hygiene measures may help keep symptoms under control. Dr. Obioha recommends using antibacterial washes that contain chlorhexidine and benzoyl peroxide, as well as exfoliating cleansers with salicylic acid.
Wear loose clothing
Friction is a major trigger for HS, so wear clothing that doesn’t rub against your skin.
Use absorbent pads and foam dressings
Absorbent patches, gauze, and foam dressings can help soak up sweat and discharge from weepy lesions. Fernandez recommends flexible dressings that will conform to areas such as the armpit without creating friction. Change dressings regularly, so the area doesn’t become moist.
Apply a warm compress
Do this for 10 minutes at a time to help reduce the pain and swelling of active flares.
Change up your shaving routine
If possible, don’t shave areas prone to HS, to help prevent ingrown hairs, recommends Sokumbi. Another option is laser hair removal, which eliminates the actual follicles. “Follicular occlusion is at the heart of HS, so if you can get rid of the hair follicles early on, that’s something to consider,” she explains.
Get support
If you’re having trouble finding a dermatologist experienced in treating Black people’s skin or would like to connect with others who are dealing with HS, visit the Hidradenitis Suppurativa Foundation. “It’s a patient advocate group with the goal of educating, supporting, and providing resources to HS patients,” says Fernandez. Having HS can be isolating, but you don’t have to go it alone.
