Managing Hidradenitis Suppurativa (HS) in Black Skin

Living with hidradenitis suppurativa (HS) is a lot like having a roommate you never invited:
it shows up in your most private spaces, makes a mess, and refuses to move out. For Black
people, HS doesn’t just crash the party more often it can also show up differently on the
skin and leave deeper physical and emotional marks.

The good news: HS is manageable. You may not be able to “cure” it right now, but with the
right care plan, lifestyle tweaks, and a team that understands Black skin, you can turn the
volume way down on flare-ups and take back control of your life.

What Exactly Is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a chronic inflammatory skin condition that usually starts with
painful lumps under the skin in areas where skin touches skin like the armpits, under the
breasts, groin, buttocks, and inner thighs. These lumps can turn into abscesses, drain
fluid, form tunnels (sinus tracts) under the skin, and eventually leave scars.

In the United States, HS is estimated to affect up to about 1% of the population, but it’s
often underdiagnosed or mistaken for “recurrent boils” or infections. For many people, it
takes years to get the right name for what’s happening to their skin and during that time,
the disease can quietly progress.

Why HS Hits Black Skin Harder

Research shows that HS is significantly more common in Black Americans than in White
Americans some estimates suggest it may be more than three times as prevalent in Black
individuals, and Black patients are more likely to be female. On top of that, Black patients
often face longer delays before getting a diagnosis.

Several factors may play into this disparity:

• Under-recognition on darker skin tones: Inflammation and color changes can
  look different on brown and Black skin, so early signs may be missed.
• Structural and social barriers: Limited access to dermatologists,
  underinsurance, and experiences of bias in healthcare all increase the odds that HS
  goes untreated.
• Higher rates of certain risk factors: HS has been linked with smoking,
  higher body weight, and metabolic issues, which also disproportionately affect some Black
  communities due to social and economic factors.

None of this is your fault. HS is not a “hygiene problem” and not a punishment. It’s a
medical condition that deserves serious, evidence-based care and you deserve to be taken
seriously when you ask for it.

How HS Looks on Black and Brown Skin

Textbooks often show skin conditions on pale skin, which is… not super helpful if your skin
doesn’t look like that. On Black and brown skin, HS can show up with:

• Dark patches or spots (post-inflammatory hyperpigmentation) after flares
  heal.
• Raised, thick scars that may look like keloids or hypertrophic scars.
• Less obvious redness: Instead of bright red, inflamed areas may look
  dark, purple, or grayish.

Because the color changes can be subtle or just look like “dark skin folds,” HS might be
misdiagnosed as razor bumps, folliculitis, or simple scarring especially in the groin,
bikini area, and underarms.

Step One: Getting the Right Diagnosis

If you suspect HS, the first big win is a clear diagnosis from a clinician who knows the
condition well, ideally a dermatologist or a primary care clinician with HS experience.
Look for someone who:

• Takes a detailed history where the bumps appear, how often they flare, family history,
  and what you’ve tried.
• Examines multiple areas (not just one painful spot) and looks for tunnels and scars.
• Talks about staging (such as Hurley stages I–III), which helps guide
  treatment choices.

If you don’t feel heard, or the visit ends with “it’s just ingrown hairs,” it’s okay to seek
a second opinion especially from a dermatologist who specializes in skin of color or
has experience treating HS in Black patients.

Medical Treatments for HS (and What to Ask About)

There’s no one-size-fits-all HS treatment. Most people need a combination of medications,
procedures, and lifestyle changes. Here are common medical tools your clinician might
discuss:

Topicals and Antibiotics

• Topical treatments: Antibacterial washes (such as benzoyl peroxide) or
  topical antibiotics may help reduce bacteria on the skin and calm mild disease.
• Oral antibiotics: Often used in early or moderate HS to reduce
  inflammation and infection. They may be given for weeks or months at a time.

If you’re on long-term antibiotics, it’s reasonable to ask how long you’ll take them and
what the “next step” will be if they stop working.

Biologics and Advanced Therapies

For moderate to severe HS, biologic medications are now a cornerstone of
treatment. These injectable drugs calm specific parts of the immune system driving HS.
The FDA has approved biologics like adalimumab and secukinumab for HS, and more are being
studied.

Questions to ask your clinician might include:

• “Am I a candidate for a biologic, based on my stage and flare pattern?”
• “How long before we expect to see results?”
• “What monitoring do I need for side effects?”

Hormonal Treatments

Because HS can flare around menstrual cycles in some people, hormonal options such as
certain birth control pills, spironolactone, or other hormone-related medications may help
stabilize symptoms. Not everyone benefits, but if you notice a monthly pattern, it’s worth
mentioning.

Pain Management

HS pain isn’t “just” skin pain. It can be deep, throbbing, nerve-like, and emotionally
exhausting. Pain plans might include:

• Over-the-counter pain relievers, when appropriate.
• Short-term prescription pain medications for bad flares.
• Nerve-targeting medications or antidepressants for chronic pain, especially when HS
  affects sleep and mood.

Surgical and Procedural Options

For areas with stubborn tunnels, repeated abscesses, or extensive scarring, surgery can
offer real relief. Options include:

• Deroofing: Removing the “roof” of tunnels so they can heal from the
  inside out.
• Excision: Removing diseased skin in a problem area, sometimes with
  reconstruction.
• Laser therapies: Certain lasers may reduce hair, inflammation, or
  scarring.

In Black skin, your surgeon should factor in the higher risk of hyperpigmentation and
keloid-like scarring and choose techniques and aftercare plans that respect how your skin
heals.

Daily Self-Care for HS in Black Skin

Medical treatment is only half the story. The other half lives in your everyday routines:
what you wear, how you wash, whether you smoke, and even how you manage stress. Studies
suggest that lifestyle changes can make a real difference in HS symptoms and flare frequency.

Be Kind to Your Skin Folds

• Use gentle, fragrance-free cleansers rather than harsh soaps or scrubs.
• Pat don’t rub areas dry, and avoid loofahs or rough exfoliation that can irritate
  hair follicles.
• Consider non-friction clothing: soft, breathable fabrics, seamless
  underwear, and sports bras that don’t dig in.
• If you remove hair, ask about less irritating options like clipping, chemical depilatories
  suitable for sensitive skin, or laser hair removal with devices safe for darker skin.

Weight, Movement, and Food

HS is not caused by weight, but extra weight can worsen friction and inflammation in skin
folds. Studies show that weight loss in people who are overweight may reduce flare-ups and,
in some cases, dramatically improve HS.

You don’t have to chase a “perfect” body. Even modest, sustainable changes more daily
walking, gentle strength training, or swapping some ultra-processed foods for whole foods
can help your skin and your overall health.

Some people notice that dairy or high–glycemic-index foods (like sugary drinks and white
bread) flare their HS. There’s no one HS diet, but keeping a symptom journal and discussing
patterns with a clinician or dietitian can be helpful.

Smoking and HS: A Tough but Powerful Lever

Smoking is one of the strongest lifestyle-related risk factors for HS. Research suggests
that quitting smoking and staying smoke-free is linked to a lower risk of developing HS,
and may also help reduce flare severity in people who already have it.

Quitting is not easy, especially when nicotine is also your go-to stress relief. But getting
help (from counseling, medications, or quit lines) can pay off for both your skin and your
long-term health.

Dealing with Dark Marks, Scars, and Keloids

Even when flares calm down, they may leave behind a map on your skin: dark patches,
thickened scars, or keloid-like overgrowths. On Black skin, these can be especially visible
and emotionally challenging.

Scar and pigment management might include:

• Sun protection: Daily sunscreen on exposed areas can prevent dark marks
  from getting darker and help them fade more evenly over time.
• Topical treatments: Ingredients like retinoids, azelaic acid, or certain
  brightening agents may help reduce hyperpigmentation (always under guidance when skin is
  sensitive or broken).
• Silicone gels or sheets: Often used to flatten and soften raised scars.
• Steroid injections or other in-office treatments: Helpful for keloid-like
  scars, but must be done carefully to avoid pigment changes in darker skin.
• Laser and energy-based devices: These can help in some cases, but it’s
  crucial to see a clinician experienced in treating darker skin tones to avoid burns or
  color changes.

Mental Health, Confidence, and Community

HS doesn’t just live on the surface. It can affect:

• How you feel in your body and in your relationships.
• Your willingness to date, be intimate, or wear certain clothes.
• Your mood, sleep, and self-esteem.

High rates of anxiety and depression have been reported in people with HS. You are not
“overreacting” if this condition feels heavy. Talking with a therapist especially one who
understands chronic illness or the unique stressors Black patients face can be a powerful
part of your care plan.

Support groups (online or in-person), HS advocacy organizations, and social media communities
focused on HS in Black skin can offer practical tips, emotional validation, and that “finally
someone gets it” feeling.

Lived Experiences: What Helps Day-to-Day

Beyond the guidelines and medication charts, there’s the reality of everyday life with HS in
Black skin. While everyone’s journey is different, many people share similar themes when they
talk about what has helped them reclaim a sense of control.

Learning That It’s Not Your Fault

Many Black patients describe years of being told their HS was caused by “not washing
properly” or shaving the wrong way. Finally hearing a clinician say, “This is a chronic
inflammatory disease, and it’s not your fault,” can be life-changing. That shift away from
blame and toward understanding often makes it easier to seek help and stick with treatment.

Some people share that once they understood HS as a medical condition, they felt more
comfortable talking to partners, friends, or family about why they sometimes walk slowly, sit
carefully, or avoid certain outfits. Instead of hiding bruised under layers of denial and
oversized clothing, they could say, “My skin condition is flaring today; I just need to move
a little differently.”

Small Habit Changes That Actually Stick

A full lifestyle overhaul is overwhelming but small, sustainable changes often matter most.
For example, someone might start by swapping tight skinny jeans for soft joggers on high-friction
days, then gradually add other tweaks: a gentle antibacterial wash in the shower, a new
deodorant that doesn’t sting open areas, or a breathable sports bra that doesn’t rub under
the breasts.

Another common story: a person who smoked for years and used cigarettes to cope with stress
gradually cutting down with help from a quit coach. They often describe not just fewer
flare-ups over time, but also deeper breaths, more energy, and a sense of pride that they did
something incredibly hard for themselves and their health.

Owning the Appointment

Many Black patients with HS talk about how intimidating medical visits can feel, especially
after dismissive experiences. Over time, some learn to “own” their appointments by bringing
a written list of questions, photos of flares, and a friend or family member for support.

This might sound simple, but it can change the tone of the visit: instead of feeling rushed
or silenced, you become an active partner in your care. People often describe the first
visit where a provider says, “Let’s talk about a long-term plan, not just today’s flare,” as
a turning point a moment when HS becomes something they can manage, not just endure.

Reclaiming Body Confidence

HS scars can make anyone feel self-conscious, and that pressure can be magnified by beauty
standards that rarely show real Black bodies with real texture, scars, and dark marks. Some
people find healing in small acts of body acceptance: wearing a swimsuit with artful cutouts
instead of total coverage, choosing soft bralettes instead of heavy padding, or taking photos
they keep just for themselves to document healing instead of only capturing “perfect” days.

Others feel empowered by connecting with influencers, advocates, or groups where people
openly share pictures of their HS scars, hyperpigmentation, and all. Seeing scars on someone
who looks like you and seeing them still laughing, dating, and living their lives can
quietly rewire what you believe is possible for your own future.

Finding Your Version of Control

Ultimately, people living with HS in Black skin often say that “control” doesn’t mean never
flaring again. It means understanding their triggers, having a clear plan for flare days,
knowing who to call when things get bad, and feeling that their care team respects them.

Your HS story is uniquely yours, but you don’t have to write it alone. With the right
combination of medical treatment, daily habits, and emotional support and with clinicians
who understand how HS behaves in Black skin you can move from just surviving your symptoms
to actively designing a life where HS is part of the picture, but not the whole frame.

Key Takeaways

• HS is more common and often more severe in Black individuals, but it is manageable.
• Black skin may show HS with dark marks, raised scars, and subtle color changes that are
  sometimes overlooked.
• Effective care often combines medications (including biologics for moderate to severe HS),
  procedures, and lifestyle changes.
• Gentle skin care, weight management where appropriate, and smoking cessation can meaningfully
  reduce flares.
• Scars and hyperpigmentation deserve attention too especially in darker skin tones, where
  treatment must be tailored to reduce the risk of further pigment changes.
• Mental health support and community can be just as crucial as creams, pills, and surgeries.