Aileen Y. Chang

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition with early onset and disproportionate impact on females and African American youth. In our cross‐sectional study of 9695 pediatric HS patients in a single US health system, pediatric patients residing in neighborhoods with lower SES had greater odds of having a new HS diagnosis in unadjusted models and after sequential adjustment for age, sex, and race and ethnicity. Fully adjusted odds ratios (95% confidence intervals) were neighborhood SES quintile, Q1 (lowest): 4.05 (1.76–9.32), Q2: 2.86 (1.13–7.22), Q3: 2.94 (1.22–7.09), Q4: 1.46 (0.55–3.90) ( p for linear trend < 0.001), with similar findings in sensitivity analyses. These findings suggest neighborhood factors may contribute to HS diagnosis, highlighting the need to identify and address modifiable, neighborhood factors that influence HS diagnosis.

Importance: Latine patients with hidradenitis suppurativa (HS) are reported to experience more severe disease and longer delays to diagnosis compared with White patients with HS. Objective: To assess the implications of health care system factors in HS care experiences for Latine patients. Design, Setting, and Participants: From June 2024 through March 2025, this qualitative study recruited English- and Spanish-language preferring Latine adults diagnosed with HS from dermatology clinics at 2 academic medical centers and 2 county hospitals in California. Deidentified audio recordings were transcribed and translated from semistructured interviews conducted by a bilingual Latine interviewer. Main Outcomes and Measures: After transcripts were coded, a thematic analysis was conducted to develop themes that captured the range of participants’ experiences, attitudes, behaviors, and beliefs related to receiving health care for HS and implementing HS care plans throughout their HS care journey, including the time before they received care from their current dermatologist. Results: Among the 24 Latine patients included in the analysis, the median (IQR) age was 37.5 (32.75-44.25) years, 17 (71%) were female, 11 (46%) preferred Spanish, and 19 (79%) had Hurley stage 2 or 3 disease. Three themes were developed. First, unaddressed wound care and pain management burdens patients with self-directed care, with 2 subthemes: (1) insufficient guidance for patients’ wound care and pain management and (2) self-directed care in response to limited health care system support for pain management and wound care creates personal burden. Second, perceived discrimination during dermatology visits leads to avoidance of care. Third, patient-centered care remains a challenge with phone or video interpreter-mediated communication. Conclusions and Relevance: In this study, many Latine participants with HS experienced unaddressed wound care and pain management needs, perceived discrimination, and challenges with interpreter-mediated communication during care with a dermatologist. Interventions are needed to prioritize wound care and pain management in multidisciplinary care plans and optimize patient-centered HS care.

Background: The experience of homelessness is a growing problem in the USA. Environmental exposures, chronic medical conditions and barriers to personal hygiene could increase risk of dermatological disease. Objectives: To evaluate the association of homelessness with receiving a dermatological diagnosis and to compare dermatological diagnoses between unhoused and housed individuals. Methods: We conducted a cross-sectional study of the ‘All of Us’ database, a national dataset from the USA with detailed participant-reported housing information. We constructed logistic regression models with dermatological diagnosis as binary outcome, housing status as binary exposure, and age, gender, race and ethnicity, geographical region, educational attainment, serious mental illness, alcohol-use disorder, and cocaine, opioid or stimulant drug use as confounders. Results: Among 257 701 participants, people experiencing homelessness had lower odds of being diagnosed with any dermatological disease [adjusted odds ratio (aOR) 0.68, 95% confidence interval (CI) 0.63–0.72; P < 0.001]. Of participants with at least one dermatological diagnosis, people experiencing homelessness had greater odds of being diagnosed with bacterial skin infections (aOR 2.20, 95% CI 1.5–2.50; P < 0.001) and ectoparasitic disease (aOR 3.12, 95% CI 2.30–4.17; P < 0.001) but lower odds of all other diseases. Conclusions: Our results underscore the need to improve access to care and water, sanitation and hygiene services for people experiencing homelessness to reduce risk of bacterial skin infection and ectoparasitic infestations.

Importance: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition. Risk factors for developing HS (eg smoking and obesity) are influenced by social drivers of health at the neighborhood level. However, the association of neighborhood-level socioeconomic status (nSES) and HS has not been adequately assessed.Objective: To evaluate the association of nSES with new HS diagnoses among dermatology patients within a single health system.Design, Setting, and Participants: This was a cross-sectional study of patients of the dermatology clinics at the University of California San Francisco health system between August 1, 2019, and May 31, 2024, who were also residents of the San Francisco Bay Area at index visit. Data analyses were performed from June 1, 2024, to February 11, 2025.Exposure: Census tract-level index measure of nSES that incorporated income, poverty, housing cost, rental cost, education, occupation, and employment. Quintiles of nSES were assigned based on nSES distribution in the San Francisco Bay Area counties.Main Outcomes and Measures: A new HS diagnosis during the study period, identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code, and confirmed by medical record review. Logistic regression models were constructed and fit by generalized estimating equations accounting for clustering by census tract with nSES quintile as the primary exposure (reference used was quintile 5, the highest nSES quintile); new HS diagnosis as the binary outcome; and age, sex, and race and ethnicity as confounders. In secondary analyses, smoking status, obesity, and health insurance type were assessed as possible mediators.Results: The analyses included a total of 65 766 patients (mean [SD] age, 50.4 [18.3] years; 41.8% female), of whom 485 (0.7%) had a new HS diagnosis. Greater odds of a new HS diagnosis were observed in lower-SES neighborhoods (Q1-Q4)—after adjusting for age, sex, and race and ethnicity, odds ratio for Q1 was 3.32 (95% CI, 2.46-4.49); Q2, 2.25 (95% CI, 1.62-3.12); Q3, 1.97 (95% CI, 1.46-2.66); and Q4, 1.44 (95% CI, 1.06-1.96) (P <.001 [linear trend]). In race-stratified analyses, greater odds of a new HS diagnosis were observed among patients residing in lower-SES neighborhoods, although this pattern did not reach statistical significance at the 5% level in all racial and ethnic groups.Conclusions and Relevance: This cross-sectional study found that nSES was independently associated with a new diagnosis of HS among dermatology patients. This finding supports the hypothesis that neighborhood-level factors may influence the development of HS.

Importance: Scabies, bedbug, and body lice infestations are caused by organisms that live on or in the skin, on clothing, or in the environment and commonly cause pruritus and rash. In 2021, approximately 622 million incident cases of scabies occurred globally. Data on bedbug infestations are limited. Body lice prevalence ranges from 4.1% to 35% among persons experiencing homelessness worldwide.Observations: Scabies is caused by mites (Sarcoptes scabiei) that burrow into the epidermis. Transmission primarily occurs from prolonged skin-to-skin contact with an individual who has an infestation. Common scabies is characterized by excoriated pruritic papules, plaques, and pathognomonic burrows on finger/toe web spaces, volar wrists, ankles, axillae, buttocks, male genitalia, and areolae. Permethrin cream and oral ivermectin are first-line treatments for adults, with similar clearance rates by week 2 (74% with permethrin vs 68% with ivermectin; relative risk, 0.91; 95% CI, 0.76-1.08). Treatment failure can occur with oral ivermectin (11.8%; 95% CI, 8.4%-15.4%) and topical permethrin (10.8%; 95% CI, 7.5%-14.5%). Bedbugs (Cimex lectularius, Cimex hemipterus) are insects that live on mattresses and furniture and feed on blood nocturnally, causing linear pruritic erythematous papules. New skin lesions on waking, cohabitants with similar symptoms, and recently residing in a high-occupancy setting should raise suspicion. Treatment requires eradication with pest management. Body lice (Pediculus humanus humanus) are insects found on clothing that travel to the skin for blood meals. Body lice bites cause pruritic excoriated macules/papules and hyperpigmentation in areas where clothing seams contact skin. Treatment and prevention require at least once-weekly bathing and laundering of clothing and bedding.Conclusions and Relevance: Scabies, bedbug, and body lice infestations are common. Accurate diagnosis requires taking a history, including social drivers of health (eg, housing status, living environment), and physical examination. First-line treatments include scabicides for patients with common scabies and their close contacts. Scabies, bedbug, and body lice infestations should be treated with decontamination measures.

Importance: Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients’ perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated.Objective: To understand patients’ perspectives on social risk screening and documentation in a dermatology clinic.Design, Setting, and Participants: This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023.Main Outcomes and Measures: There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR).Results: A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic.Conclusions and Relevance: Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients’ trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.