Hidradenitis Suppurativa in the Pediatric Population

Abstract

Background/Objectives: Hidradenitis suppurativa (HS) has not been sufficiently studied or characterized in the pediatric population. The purpose of this study is to describe the demographics, clinical features, risk factors, and associated comorbidities in pediatric patients with HS. Methods: This is a retrospective study from a single, safety-net hospital. Subjects (n = 304) include pediatric patients (ages 4 to 18 years old) who were clinically diagnosed with HS from 2012 to 2021. All medical charts were reviewed, and the study outcome measures were collected within 6 months of the patient's HS diagnosis date. Results: Of 303 pediatric patients with HS, 253 (83.5%) were female and 50 (16.5%) were male. Of 286 patients, 185 (64.7%) were Black/African American, 31 (10.8%) were White, 6 (2.1%) were Asian; 3 (1.0%) were Native American; and 60 (21.0%) were Hispanic/Latino. The mean age(s) at diagnosis and symptom onset were 15 and 13 years old, respectively, with a mean delay to diagnosis of 2 years. A positive family history of HS was reported in 39/109 (35.8%) patients, and smoking was reported in 33/241 (11.8%) patients. Obesity (BMI percentile based on sex and age) was the most prevalent comorbidity associated with pediatric HS. At the time of HS diagnosis, 157 (64.1%) were obese, 41 (16.7%) were overweight, and 47 (19.2%) had a normal BMI percentile. Acne vulgaris (68/189 [36.0%]) was the second most common comorbidity. Of 172 patients, 43 (25.0%) had acanthosis nigricans; 28 (16.2%) had polycystic ovary syndrome (PCOS); 32 (18.4%) had depression; 23 (13.2%) had anxiety; 18 (10.5%) had prediabetes/insulin resistance; 12 (6.9%) had trisomy 21; 11 (6.4%) had hyperlipidemia; 5 (2.9%) had type 2 diabetes; 5 (2.9%) had precocious puberty; and 5 (2.9%) had thyroid disorders. None had type 1 diabetes or metabolic syndrome. The most common clinical features were pain/tenderness (168/187 [89.9%]), pustules/papules (124/190 [65.3%]), discharge/drainage (116/188 [61.7%]), and deep-seated nodules (96/190 [50.5%]). Scarring was present in 83/190 (43.7%) patients at the time of diagnosis. The most common sites of involvement were the axillary, inguinal folds/inner thighs, and the pubic area. Conclusions: A significant number of patients presented with scarring, a complication of advanced HS, at the time of diagnosis. This suggests that HS is underdiagnosed in the pediatric population. Thus, providers may consider screening adolescents with HS risk factors (female, African American, and family history of HS) and associated comorbid-ities (obesity, acne, and acanthosis nigricans).