Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature

Abstract

Background Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle affecting apocrine glands‐rich areas of the body. The disease usually occurs after puberty leading to painful nodules, abscesses, tunnels and scarring. Although uncommonly, HS can also occur in children and adolescents. Objective Our objective was to describe the epidemiology, characteristics, predisposing factors and clinical course of HS in paediatric patients. Methods The retrospective cohort study included patients with HS, who have been diagnosed in Dessau Medical Center and reported development of HS during childhood or adolescence, fulfilled the diagnostic criteria for HS and had a follow‐up period of at least one year. A systematic review was conducted on MEDLINE, EMBASE and CENTRAL on 19 March 2020 using the terms ‘hidradenitis’ or ‘acne inversa’ together with the terms ‘children’, ‘paediatric’ and ‘adolescence’. Results Twenty paediatric patients [1 child (0.22%), 19 adolescents (4.25%)] were detected out of 447 patients evaluated (4.5%) with a male to female ratio of 1.86 : 1. The median age at diagnosis was 17 years [interquartile range (IQR) 16–18] and the median age at onset 15 years (IQR: 14–16.5). The majority of the patients suffered from moderate disease were overweight or obese and non‐smokers. The most common comorbid disorder was acne vulgaris. The systematic review revealed reports with data heterogeneity and lack of systematic documentation of specific demographic characteristics. Most paediatric patients were female, obese and non‐smokers, with considerable comorbid disorders. Conclusions Hidradenitis suppurativa in Germany may affect children and adolescents exhibiting a particular phenotype of mainly male non‐smokers.

Multidisciplinary Management of Adolescents with Hidradenitis Suppurativa – Series of Cases and Literature Review

“…This shift in sex distribution is unexplained, but the authors hypothesize that, whereas the role of ovarian hormones in the pathogenesis of HS may underlie much of adult-onset disease, it is less important in prepubescent disease. 2 , 9 …”

“…5 , 11 Obesity is a condition associated with this disease and seems to be aggravated by the metabolic syndrome, but also smoking, which increases 9.4 times the risk of developing this condition. 2 , 12 , 13 Although the disease is classically associated with sweat gland damage, recent studies show that it is actually a condition of the follicular epithelium resulting from repetitive mechanical stress in genetically susceptible individuals. 14 Thus, the occlusion of the pilosebaceous units leads to inflammation and the appearance of abscesses, and the subsequent rupture of the follicles leads to the appearance of fistulas that will become secondary.…”

“…It is a rare disease in children and the recorded literature is correspondingly scarce. [1][2][3] In a recent German study, only 4.5% of all HS patients were children. 2 HS may be associated with various somatic and psychiatric comorbidities, but data regarding comorbidities in young patients with HS are also sparse.…”

“… 1–3 In a recent German study, only 4.5% of all HS patients were children. 2 HS may be associated with various somatic and psychiatric comorbidities, but data regarding comorbidities in young patients with HS are also sparse. 4 Due to the recurrent nature, unpleasant odor, associated pain, surgery and subsequent scarring, the disease has a debilitating potential in adolescents who may experience psychosocial disorders and impaired quality of life (QoL).…”

Hidradenitis suppurativa/Acne inversa: Von „orphan disease“ zu heilbarer entzündlicher Hauterkrankung

“…Neben der klassischen sporadischen HS gibt es zahlreiche seltene HS-Varianten, wie die familiäre und die pädiatrische Formen sowie die syndromale HS [25]. Im Gegensatz zu den erwachsenen HS-Patienten rauchen HS-befallene Kinder nicht [20]. Es gibt Berichte mit großer Variation der HS-Prävalenz in verschiedenen Ländern, nämlich von 0,00033-4,1 %, die auch vom untersuchten Kollektiv und der angewandten Methode abhängig sind [26].…”