TL;DR
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Dermatologist Julia M. Riley discussed hidradenitis suppurativa (HS) in skin of color at a European dermatology meeting, highlighting reported disparities affecting Black patients and practical issues in recognizing and managing the disease. Her comments addressed diagnostic delays, pigment changes, keloid risk, access to dermatology and concerns about biologic treatment.
Black patients in the United States have a threefold higher prevalence of hidradenitis suppurativa than other patients, and may face more severe disease, longer diagnostic delays and greater health care use, dermatologist Julia M. Riley said in a MedPage Today video about her presentation at a European Academy of Dermatology and Venereology meeting in Vienna. Riley, of Northwestern University Feinberg School of Medicine, discussed how clinicians can recognize HS in pigmented skin and address barriers that can delay treatment.
Riley said her presentation covered identifying inflammation in skin of color and recognizing post-inflammatory pigment changes, which may also help clinicians assess disease severity. She also discussed the overlap between HS and keloids, raised scars that can form at sites of inflammation or after procedures. Her comments were based on her meeting presentation; the video did not provide new study results or detailed methods behind the prevalence figure.
She described delays in care as multifactorial, including insurance obstacles and long waits for dermatology appointments. HS can involve chronic symptoms and flares with worsening pain and drainage, Riley said, which can substantially affect quality of life. She suggested timely initial appointments and a way for patients to contact their care team during flares, such as an online messaging system.
Riley said keloids may develop directly at inflamed HS lesions or after surgery, including a procedure called deroofing. For patients prone to keloids, she said clinicians should discuss that possibility before an operation. She described intralesional steroid injections as one option used to reduce keloid symptoms or flatten the scar. When keloids arise at HS sites, she said, treating inflammation—including with biologic medicines when appropriate—may help prevent additional lesions.
Reducing Delays in HS Care
The issues Riley raised matter because recognition, access and treatment decisions can shape how long patients live with painful flares before receiving specialist care. If inflammation and pigment changes are harder to identify in darker skin, clinicians may need to account for how HS appears across skin tones rather than relying on one visual presentation. Riley’s remarks point to practical areas for care teams: reducing appointment waits, offering clear routes to report flares and discussing potential treatment concerns.
Her discussion also highlights the need to address keloid risk without overlooking HS symptoms. Fear of scarring may affect decisions about surgery, while untreated inflammation can itself lead to lesions and scars. Riley said patients with a history of keloids should receive counseling about procedural risks and available management options. The report does not establish how common these outcomes are or compare the effectiveness of different approaches.
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HS Disparities and Skin Changes
Hidradenitis suppurativa is a chronic inflammatory skin disease that can involve recurring painful lesions and drainage. Riley’s meeting presentation focused on its impact in skin of color, particularly reported differences affecting Black patients. She cited U.S. data indicating a threefold higher prevalence among Black patients, alongside more severe disease, longer diagnostic delays and greater health care utilization among people with HS.
The MedPage Today report centers on Riley’s interview and presentation rather than a newly published clinical trial or formal guideline. It does not describe the underlying studies, define the comparison groups for the prevalence estimate or quantify the amount of diagnostic delay. The account therefore provides clinical themes and Riley’s perspective, not a full evidence review.
“There’s a threefold higher prevalence of HS, specifically in Black patients.”
— Julia M. Riley, MD, of Northwestern University Feinberg School of Medicine, as quoted in the MedPage Today report
Evidence and Treatment Details
The report does not specify which studies support the threefold prevalence estimate, how the comparison was calculated or how much longer diagnostic delays are for Black patients. It also gives no patient numbers, outcome data or treatment comparisons. Riley’s comments describe topics from a meeting presentation, so they should not be read as evidence that one care strategy works for every patient.
Details also remain limited on how clinicians should choose among HS treatments, when biologic medicines are appropriate and how often keloids develop after lesions or surgery. The report notes that biologic hesitancy can be a concern but does not identify its causes or describe a specific counseling program. Individual treatment decisions and procedural risks depend on a patient’s circumstances and should be discussed with a qualified clinician.
Applying the Meeting’s Care Priorities
The report does not announce a new guideline, trial or policy change. The next steps it identifies are clinical: improve access to timely dermatology visits, give patients a reliable way to contact care teams during flares, and recognize inflammation and pigment changes across skin tones. Riley also called for conversations about biologic treatment concerns and advance counseling about possible keloids before procedures.
Further evidence would be needed to determine how widespread each barrier is and which interventions most effectively shorten delays or improve outcomes. Until then, the report presents these points as issues for clinicians and patients to discuss, rather than a single prescribed care pathway.
Key Questions
What did Julia Riley report about HS in Black patients?
Riley cited U.S. data indicating a threefold higher prevalence of HS among Black patients. She also said people with HS may experience more severe disease, longer diagnostic delays and greater health care use. The report does not provide details of the underlying studies.
Why can HS be difficult to recognize in skin of color?
Riley’s presentation addressed how clinicians can recognize inflammation and post-inflammatory pigment changes in pigmented skin. The report does not offer a diagnostic checklist or describe a single appearance that applies to everyone.
Can HS lesions or surgery lead to keloids?
Riley said keloids can form at inflamed HS lesions or after procedures such as deroofing. She recommended discussing possible scarring with patients who have a history or predisposition to keloids, and said intralesional steroid injections are used to treat symptoms or flatten scars.
What barriers to HS care did Riley identify?
She cited insurance barriers and long waits for dermatology appointments, as well as the need for patients to contact care teams during painful flares. The report does not quantify how common these barriers are.
Source: medpagetoday.com
