Racial Differences in Biologic Treatment for Hidradenitis Suppurativa Highlighted

Toluwalashe Onamusi, MD

Credit: LinkedIn

While new findings suggest a lack of statistically significant differences in biologic treatments between non-Hispanic Black and non-Hispanic White patients with hidradenitis suppurativa (HS), White patients overall received biologics more frequently than Black patients.¹

These findings and others were the result of a new single-center study authored in part by Toluwalashe Onamusi, MD, from the department of dermatology at Case Western Reserve University School of Medicine in Cleveland. Onamusi and colleagues highlighted that, prior to their research, other studies had have suggested an increase in HS severity among patients of color and that such patients are less likely to visit a dermatologist.²

“As the current literature on racial disparities in HS focuses on adults, understanding the potential racial differences in disease profile and outcomes of pediatric HS may help deliver equitable, individualized, and prompt care,” Onamusi and colleagues wrote. “This retrospective review aims to explore racial differences in the presentation, severity, and management of pediatric HS.”¹

Differences Among Pediatric Patients with HS Stratified by Race

The investigative team, with the approval of the Institutional Review Board at University Hospitals Cleveland Medical Center, conducted their retrospective, single-center study through a review of patient records. To do this, the team used ICD-9 and ICD-10 codes for HS, evaluating subjects recorded between January 2012 - December 2022.

Trial participants were required to have a clinical or biopsy-confirmed HS diagnosis, be 17 years of age or younger, and have been managed through the dermatology department at University Hospitals in order to be involved in this analysis. The investigators did not include those diagnosed by non-dermatologists.

Through the use of REDCap, the research team conducted their assessment of patient data. They carried out their statistical analyses using SPSS 28. In terms of data evaluated, the investigators looked at comorbidities, anatomic sites impacted by HS, various demographic factors, vital signs such as blood pressure and body mass index (BMI), Hurley stage classification, medication regimens, clinical characteristics, and the number of outpatient, emergency department, and hospital visits.

In total, there were 70 subjects evaluated in the study, with the majority being non-Hispanic Black (63.5%) and 89.2% being reported as female. The participants all had a mean age of 14.6 ± 1.97 years, with the most prevalent comorbidities identified by the team being acne among 37.1% and obesity among 80%.

In their assessment of the most commonly affected bodily regions, it was determined that the axillae (70%) and groin (50%) had been the most frequently impacted. The investigators also concluded that BMI averages had shown differences by race, with subjects who were Black showing a mean BMI of 35.5 ± 9.3 as opposed to 31.1 ± 8.4 among those who were White.

After assessing treatment utilization, the investigative team found that 70.2% of the Black patient cohort had been treated with systemic medications, both oral and biologic, as opposed to 52.2% of those in the White patient cohort (P = .04). Among the most frequently identified clinical findings were nodules (68.6%) and scarring (54.2%).

There were 45 individuals with documented Hurley stages, and the team concluded that advanced disease, defined as stages 2 and 3, had been more common in Black subjects (31.1%) versus those who were White (8.9%). Additionally, the analysis demonstrated that use of biologic drugs showed a slight dip among Black participants compared to White participants (8.5% versus 13.0%, respectively).

Patterns of healthcare implementation among subjects also showed some variation based on race in the team’s final assessment. Specifically, the investigators reported that Black subjects averaged 3.06 ± 2.5 outpatient visits, 1.02 ± 2.1 visits to emergency departments, and 0.53 ± 1.4 hospitalizations, whereas White subjects were found to have had 4.65 ± 6.2 outpatient visits, 0.57 ± 1.2 visits to emergency departments, and 0.18 ± 0.4 hospitalizations.

Overall, the research team noted that the data highlight racial disparities in for pediatric patients who suffer from HS. The recognition of such distinctions, they noted, is vital for patient outcome improvement and for the eventual formulation of targeted management strategies addressing patients’ unique needs.

"Study limitations include the retrospective nature, small sample size due to inclusion criteria, and incomplete documentation of Hurley staging in the medical record," they wrote. "Additionally, this study may not be generalizable because it is a single-center study in an urban setting."¹

References

1. Onamusi, T., Murphy, J. and Shah, S.D. (2025), Racial Differences in Disease Characteristics of Pediatric Hidradenitis Suppurativa. Pediatric Dermatology. https://doi.org/10.1111/pde.15891.

2. A. Garg, J. S. Kirby, J. Lavian, G. Lin, and A. Strunk, “Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States,” JAMA Dermatology 153, no. 8 (2017): 760–764, https://doi.org/10.1001/jamadermatol.2017.0201.