Hidradenitis Suppurativa in Skin of Color

Overview / Definition Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent, painful nodules, abscesses, and sinus tracts, primarily occurring in areas where skin rubs against skin. The condition can lead to significant physical discomfort and emotional distress, particularly in patients with skin of color, where the disease may be under-recognized and misdiagnosed. Epidemiology Hidradenitis Suppurativa has a prevalence of approximately 1-4% in the general population, but this may vary in different ethnic groups. Studies indicate that HS is more common in individuals with darker skin tones: Higher incidence rates have been reported in African American populations. Age of onset typically ranges from late adolescence to early adulthood. Females are affected more than males, with a ratio of around 3:1. Pathophysiology / Mechanism The exact etiology of HS remains unclear, but it is believed to involve several factors: Genetic Predisposition: Family history is noted in many cases, suggesting a hereditary component. Immune Dysregulation: HS is associated with dysregulation of the immune system, particularly the activation of the TNF-alpha pathway. Mechanical Stress: Friction in intertriginous areas triggers inflammation and follicular occlusion. Hormonal Factors: Hormonal changes may exacerbate symptoms, as HS often worsens during menstrual cycles. Clinical Presentation Patients typically present with: Recurrent Painful Nodules: These may progress to abscesses and draining sinus tracts. Common Locations: Axillary, groin, perianal, and inframammary regions are most affected. Scarring and Hyperpigmentation: Skin of color may exhibit significant post-inflammatory hyperpigmentation and scarring. Stages of HS: The Hurley staging system categorizes HS into three stages, ranging from isolated lesions to widespread disease with significant scarring. Diagnosis / Workup Diagnosis of HS is primarily clinical and involves: Patient History: A