Tiffany Mayo, MD, FAAD

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Skin of Color Savvy: HS Management in Skin of Color, with Tiffany Mayo, MD, Steven Daveluy, MD, Jasmine Ivanna Espy

02:15 Diagnostic challenges with HS in skin of color

07:01 Hesitancy in using laser hair removal

11:13 Physician blindspots with HS management

12:33 Patient experiences and stigmatization

, host Tiffany Mayo, MD, leads a dynamic conversation on hidradenitis suppurativa (HS) in patients with diverse skin types, joined by dermatologist Steven Daveluy, MD, and patient advocate Jasmine Ivanna Espy.

Together, they offer a unique triangulation of perspectives—clinician, researcher, and lived experience—that frames HS not only as a medical challenge but also a public health, quality-of-life, and equity issue.

The conversation begins with Daveluy highlighting key diagnostic challenges of HS in patients with skin of color. Notably, studies show a prolonged diagnostic delay—seven to ten years on average—that is even longer in patients with skin of color. Contributing factors include clinical misrecognition due to erythema presenting differently in richly pigmented skin, leading to underdiagnosis or misdiagnosis. Daveluy also discusses disparities in disease severity and access to dermatologic care, underscoring that while HS itself is not more severe in patients of color biologically, delayed diagnosis and limited access to early interventions result in more advanced disease at presentation.

The discussion transitions to treatment considerations, particularly the use of laser hair removal in HS management. Daveluy explains that laser treatments are safe and effective for patients with darker skin types when used appropriately. He emphasizes that clinicians should not be deterred from using lasers for HS in skin of color, as patients often prioritize relief from pain and inflammation over potential dyspigmentation. Mayo reinforces this by noting that many providers already have the necessary tools—they simply need confidence and patient-centered guidance on how to apply them effectively.

Turning to the patient journey, Jasmine Ivanna Espy shares her powerful personal experience with HS, which began at age 13 but had not been accurately diagnosed until high school. She describes years of being misdiagnosed, experiencing physical pain and emotional isolation, and having to navigate a system that failed to validate her symptoms. Espy details the intense psychosocial toll of the disease, from clothing restrictions and social stigma to clinical depression and suicidal ideation.

Despite this, her story is one of transformation: through surgery, lifestyle changes, and community support, she ultimately achieved remission and founded a nonprofit—the Association of Hidradenitis Suppurativa and Inflammatory Diseases (AHSID)—to support others with similar experiences.

As the episode progresses, Daveluy and Espy discuss recent advances in treatment, including the growing arsenal of FDA-approved biologics and evolving surgical strategies like wide excision. Daveluy notes a shift in dermatologists’ willingness to treat HS now that more tools exist, while Espy underscores how having treatment options has empowered patients to make informed decisions rather than act out of desperation. Both stress the importance of combination therapy and in-office procedures like deroofing to manage chronic tunnels and flare-ups.

The episode closes with a call to action on building trust and centering the patient voice. Espy urges clinicians to approach patients with humility, curiosity, and respect—asking what matters most to them, acknowledging cultural and emotional factors, and fostering shared decision-making. Daveluy echoes this, encouraging dermatologists to either become that steadfast provider who does not give up on patients or develop trusted referral pathways to those who can.

Ultimately, the conversation affirms that HS care is about more than controlling lesions—it is about restoring dignity, reducing disparities, and empowering patients with both clinical and emotional support.

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Editor’s note: This episode summary was edited through the use of artificial intelligence tools.

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This episode of the SOCS podcast features an in-depth discussion between Tiffany Mayo, MD, Steven Daveluy, MD, and patient advocate Jasmine Ivanna Espy.


Tiffany Mayo, MD, FAAD

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