Pediatric Hidradenitis Suppurativa: A Cross-Sectional Study on Clinical Features and Treatment Approaches

Abstract

Background Hidradenitis suppurativa is uncommon in patients of pediatric age, and differentiation with adult-onset disease is controversial. Treatment of pediatric hidradenitis suppurativa is scarcely standardized, and specific guidelines are lacking. Objective We report the clinical features, relevant risk-factors, comorbidity profile, and treatment patterns of a hospital-based cohort of pediatric hidradenitis suppurativa Methods In a cross-sectional study data on patients’ demographics, disease-specific characteristics, early/pre-pubertal onset of disease, comorbidities, and treatment management were retrieved. Reference population data and clinical data from the national hidradenitis suppurativa disease registry were used for comparison. Results From a database of 870 patients with hidradenitis, 71 (15 males and 56 females) patients aged <18 years (mean age: 15.3 years; range 8-17 years), with mild (Hurley I, 45.1%) and moderate-severe disease (Hurley II-III, 54.9%), were retrieved. Smoking (23.9%) and overweight/obese frequencies (59.2%) were higher than reference population standards. Patient’s older age at baseline (OR 1.43, 95% CI: 1.01 to 2.02) and higher BMI (OR 1.26, 95% CI: 1.07–1.48) were the only factors associated with moderate-severe disease. Family history and early/pre-pubertal onset of disease were not associated with severity or extent of disease. Sebaceous-follicular comorbid conditions were associated with cigarette smoking ( P = .002). Among 81 treatment courses, clindamycin-based and zinc-sulphate-based combination regimens were most frequently used (59.3%). Female preponderance, family history of disease and extensive involvement were significantly different from the general hidradenitis suppurativa population. Conclusions Pediatric hidradenitis suppurativa presents a clinical spectrum comparable to adult-onset disease. Increased preventive measures should target obesity and smoking in this population.

A bibliometric analysis of hidradenitis suppurativa literature over the past 50 years

“…Of all the articles, fewer than 20% researched morbidity among the pediatric population, especially adolescents. While the disease can be represented at any age, it seems essential to expand knowledge in this age group that can suffer from the disease for many years and in a variety of clinical presentations, as well as with a difficulty in diagnosis and adjusting chronic treatment with few adverse effects 26–28 …”

“…While the disease can be represented at any age, it seems essential to expand knowledge in this age group that can suffer from the disease for many years and in a variety of clinical presentations, as well as with a difficulty in diagnosis and adjusting chronic treatment with few adverse effects. [26][27][28] The PubMed search database found only 39 Randomized Controlled Trials, most of them published in the last two decades (n = 30). Although this is positive progress, it is still a small number of studies concerning such a complex and not rare disease.…”

Atopic Dermatitis and Water: Is There an Optimum Water Intake Level for Improving Atopic Skin?

“…Increased body fat augments the levels of subcutaneous fat, produces skin folds, and increases surface roughness [38,39]. Consequently, several chronic systemic inflammatory skin conditions are associated with increased body weight, in both children and adults, including psoriasis [40][41][42], hidradenitis suppurativa [43], melanomas [44] and AD [45].…”

The Link Between Obesity and the Skin

“…Hidradenitis suppurativa (HS) characterized by chronic inflammatory nodules, cysts, and abscesses, resolves with scar formation and engage the skin folds. Obesity is a risk factor for HS both in children and in adults ( 42 , 43 ). Weight loss is associated with disease improvement ( 44 ), while bariatric surgery has been shown to worsen or induce de novo HS ( 45 ).…”