Recognizing Hidradenitis Suppurativa in Black Americans

Medically Reviewed By William C. Lloyd III, MD, FACS
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In the United States, hidradenitis suppurativa (HS) seems to affect Black people more frequently and more severely than white, Hispanic, or Asian individuals. It is not entirely clear why this is the case, although researchers are looking into potential contributing factors, including genetic and social determinants of health. Black people with HS may find it challenging to get a diagnosis, so recognizing the symptoms and advocating for your health is key.

Female on couch with left arm up stretching left side

It is possible HS is more severe in Black Americans because it may take longer for them than for white people to receive an accurate diagnosis. Doctors often misdiagnose HS as other conditions, especially in People of Color. This is due to several factors; physicians-in-training are more likely to see images of white people with skin disorders in their textbooks than People of Color, and thus may be less equipped to recognize HS in Black people. Research on HS in the Black population is historically limited, so doctors may lack education about how HS manifests in skin of color. Black people may also face barriers to quality medical care, particularly when it comes to accessing specialists like dermatologists, who are more likely to accurately diagnose and appropriately treat HS than general practitioners. Without a diagnosis, you won’t receive adequate treatment, which can lead to more significant symptoms as the disease progresses. Keep track of your symptoms and connect with a dermatologist so you are more likely to get a diagnosis without delay.

Hidradenitis suppurativa symptoms

Knowing the symptoms of HS can help you get a diagnosis faster. Be sure to let your doctor know if you have any of the signs of HS so treatment can begin quickly.

1. Blackhead-like spots

Blackheads, a common form of acne, are essentially clogged pores that appear as small, dark dots. For some, a sign of HS is blackhead-like spots in pitted areas of skin. In many cases, these spots appear in twos. Although they look like blackheads, they’re not. Called double-ended pseudocomedones, the two dark spots are actually two ends of a tiny connected tunnel. Their color may be more difficult to see on dark skin, but their indentations can be visible.

2. Discomfort

Before a breakout, your skin might be uncomfortable in the areas where lumps will form. Some people experience a burning sensation, itching, or excessive sweating.

3. Leaking bumps or sores

As HS worsens, some lumps get bigger and eventually break open. When this occurs, the lump may itch and drain foul-smelling fluid or blood. Leaking lumps are known as abscesses.

4. Painful, pea-sized lumps

HS usually begins as a single, painful, pea-sized lump under the skin. For most, this lump will not go away, even after several weeks or months. As the condition progresses, it is not uncommon for more lumps to form in the same area.

5. Skin that is slow to heal

In more serious cases of HS, skin tends to heal very slowly, especially if an abscess has broken open. For many, abscesses rupture, drain fluids, and then heal in a continuous cycle. Eventually, this cycle may lead to permanent scars.

6. Tunnels under the skin

Tunnels often drain blood or pus from HS abscesses, and they usually heal very slowly. Without treatment, tunnels may form under the affected skin and connect two or more abscesses to each other. For some, surgery is necessary to uncover tunnels or remove areas of skin where HS occurs frequently.

When to see a doctor

Doctors often mistake HS for other medical conditions, which may cause you to go months or years without receiving the treatment you need. If you think you may have HS, be sure to let your doctor know so they can perform a thorough skin evaluation. An accurate diagnosis can help you avoid unpleasant complications, such as infections, pain, or slow-healing wounds, which may negatively affect your quality of life.

It is also important to know which HS symptoms might indicate that the condition is worsening. That way, your doctor can help you find treatments to help your skin heal.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 Jan 24
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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