Dr James Song Addresses Disparities in HS Presentation, Severity Among Diverse Patients

James Song, MD, director of clinical research and associate chief medical officer at Frontier Dermatology, highlights key insights from his 2023 Fall Clinical Dermatology Conference session about recognizing how atopic dermatitis, psoriasis, and hidradenitis suppurativa (HS) affect people differently based on severity and skin tone.

Song co-presented the session with Andrew Alexis, MD, MPH, Andrew Alexis, MD, MPH, FAAD, vice chair for diversity and inclusion for the Department of Dermatology and a dermatologist at the Center for Diverse Skin Complexions at Weill Cornell Medicine in New York City; and Linda Stein Gold, MD, director of Dermatology Clinical Research at Henry Ford Health System.

He explained that there are different presentations of skin diseases in patients who have darker skin, and not having a clear understanding of these differences can result in both a delay in diagnosis and a delay in treatment start.

In addition, patient with skin of color often present with more advanced disease. In a disease like psoriasis, this may not be a problem because there are so many therapies available that can effectively treat the disease. However, with HS, medications don't work as well once the patient has advanced enough to develop tunnels or scarring.

According to Song, patients with skin of color have to get to a dermatologist earlier when there is a better window of opportunity to intervene for the best response to treatment.

In addition to HS being more common in Black and Latinx patients, there is also a disproportionately higher number of patients with skin of color who have severe disease, which is tied to their social determinants of health, he said. They may not have access to specialists or newer medications. They may have lower health literacy. Or due to historical injustices by the medical system, they may simply not trust the system anymore.