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Hidradenitis suppurativa in Black and White patients - a clinical study
A S Byrd1, A Z Rosenberg, W D Shipman
1Department of Dermatology, Howard University College of Medicine, Washington, DC, USA. dr.giovanni.damiani@gmail.com.
Insights
Black patients with hidradenitis suppurativa (HS) show more severe disease than White patients, though clinical presentations are similar. This suggests social factors may influence ethnic disparities in HS severity.
Area of Science:
- Dermatology
- Epidemiology
- Genetics
Background:
- Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition.
- HS is suggested to be more prevalent and cause greater morbidity in Black patients compared to White patients, but clinical data are limited.
Purpose of the Study:
- To describe risk factors, disease severity, and clinical phenotypes of HS in Black and White patients.
- To investigate potential ethnic differences in HS presentation and severity.
Main Methods:
- Retrospective analysis of 278 HS patients (170 Black, 108 White) treated between 1984-2019.
- Extracted clinical and sociodemographic data, and classified HS phenotypes using the van der Zee & Jemec criteria.
Main Results:
- No statistically significant ethnic differences in HS clinical presentation were observed.
- Black patients demonstrated a trend towards more severe disease (Hurley stages 2 and 3) compared to White patients (p=0.024).
- Male sex, disease duration, and smoking were independent predictors of the regular HS phenotype.
Conclusions:
- While HS demographics and phenotypical presentation may not differ significantly by ethnicity, Black patients trend towards more severe disease.
- Ethnic differences in HS severity may be influenced by social factors, underscoring the importance of ethnicity in disease outcomes.
Objective:
It is suggested that hidradenitis suppurativa (HS) is more prevalent and causes greater morbidity in Black patients than in White. Clinical data are however lacking.
Patients And Methods:
We therefore describe HS risk factors, disease severity and clinical phenotypes in the Blacks and Whites. Patients referred for HS between 1984 and 2019 at the Johns Hopkins Hospital were identified using the Pathology Data System (PDS). Clinical and sociodemographic characteristics were extracted and the van der Zee & Jemec HS clinical phenotypes were recovered.
Results:
A total of 278 patients were identified. Ethnically, 108 (38.8%) were White, and 170 (61.2%) Black. The following HS phenotypes were found: Regular (n=193, 69.4%), scarring folliculitis (n=40, 1.4%) frictional furuncle (11.2%), conglobata (n=9, 3.2%), syndromic (n=3, 1.1%) and ectopic (n=2, 0.7%). No statistically significant ethnic differences in clinical presentation were found. Blacks however had more severe diseases than Whites (p= 0.024 for trend). With multivariate logistic regression analysis, we found that male sex, disease duration, and smoking were independent predictors of regular HS phenotype. Major limitations are the limited number of cases studied and the lack of data regarding response to therapies.
Conclusions:
Demographics and phenotypical presentation of HS patients do not seem to be associated with Black ethnicity. However, there is a significant trend for Blacks to present with more Hurley stage 2 and 3 disease compared to White patients. It is speculated that ethnic differences are epiphenomena to social factors, highlighting the broader importance of ethnicity.
