Insurance disparities in hidradenitis suppurativa: A comprehensive review of demographics, outcomes, and access to care.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that disproportionately affects women, African Americans, and individuals of biracial descent. It is associated with substantial physical and psychiatric morbidity, reducing quality of life. Objective: This review analyzed disparities in treatment outcomes, disease progression, and healthcare access among HS patients based on insurance type. Methods: Using PRISMA guidelines, a comprehensive literature search identified 7 studies meeting inclusion criteria. Owing to data heterogeneity, studies were qualitatively analyzed. Results: Findings consistently demonstrated that Medicaid patients experienced worse outcomes than those with private insurance or Medicare. Medicaid patients had higher rates of comorbid conditions, including cellulitis and psychiatric disorders, greater reliance on emergency departments, and higher utilization of prescription pain medications, particularly opioids. They were also less likely to access specialized dermatologic care or advanced treatments such as biologics, despite a higher HS prevalence. These disparities were attributed to socioeconomic factors, barriers to specialist care, and limited insurance coverage for evidence-based treatments. Conclusion: Addressing insurance-related disparities could reduce disease severity, enhance medication adherence, and decrease reliance on emergency care and opioids. Future research should evaluate the impact of alternative treatments, such as laser hair removal, and examine insurance-related disparities in detail to improve outcomes for underserved populations.