Social Drivers of Health and Hidradenitis Suppurativa Care

Conclusions

• Social drivers of health and hidradenitis suppurativa influence each other bidirectionally, with social conditions affecting HS risk and HS worsening economic and social stability.
• Neighborhood disadvantage, poor walkability, unhealthy food environments, and hotter urban microclimates appear associated with higher HS burden or worse disease.
• HS can contribute to lower income, slower income growth, unemployment, and loss of employer-sponsored insurance, creating a cycle that can worsen disease control.
• Housing insecurity and inability to safely store or receive medications can directly interfere with biologic treatment delivery and should be actively assessed.
• Clinicians should ask about social drivers at the point of management planning, explain why they are asking, and not rely on charted information alone.
• Practical care changes such as alternate pharmacy delivery, nurse injection visits, cooler storage strategies, or medical respite can help patients who lack stable housing or refrigeration.
• Transportation barriers, dependent care responsibilities, and unstable housing often require flexible scheduling, flexible visit formats, and assistance with transit resources.
• HS-related stigma and isolation mean that offering peer support and patient connection resources may improve the lived experience of care.
• For patients with limited English proficiency, certified bilingual interpreters are preferred, and in-person interpreters may improve nuance, rapport, and recognition of nonverbal cues.
• Using plain language and sixth-grade-level written materials can improve recall, adherence, and decision-making in HS care.
• Addressing social drivers should be documented as influencing management, both to support better care and to justify appropriate billing and Z-code use.
• Overall, integrating social-driver assessment, communication adjustments, and community resource referral is presented as essential dermatologic care for HS patients.