Characterizing a cohort of pediatric patients with hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent, painful inflammatory nodules that form extensive draining abscesses and dermal tracts. Median age of onset in females is 19 years and in males is 23 years. A small number of cases in pediatrics have been reported, and less than 2% of patients have disease onset before 11 years. There is a paucity of knowledge about pediatric HS. An IRB-approved retrospective chart review of pediatric patients treated at the Montefiore Hidradenitis Suppurativa Treatment Center (HSTC) from January 2015 to August 2019 identified 72 individuals. Average age at initial visit was 15.5 ± 1.34 (range 12-17) years, 62 (86.1%) were female, and BMI (documented for 35 patients) was 33.0 ± 7.78 mg/kg2. Fourteen (19.4%) identified as Black or African-American, six (8.3%) as White, one (1.4%) as Asian, one (1.4%) as American Indian or Alaskan Native, and 50 (69.4%) as other or declined. Average Hurley stage was 1.64 ± 0.77, and HS-PGA was 2.42 ± 1.35. Most common location of lesions included axilla (84.7%), groin (59.7%), upper inner thighs (33.3%), breasts (22.2%) and buttocks (20.8%). Average duration of symptoms prior to HSTC visit was 40 months, and time since HS-diagnosis was 21 months. Twenty-six (36%) reported a family history of HS, and 41 (56.9%) reported personal history of other skin conditions including acne (27.8%), eczema (26.4%) and pilonidal cyst (6.9%). Co-diagnoses included obesity, polycystic ovary syndrome, asthma and trisomy 21. Therapies initiated at the initial visit included topical antibiotics (95.8%), oral antibiotics (52.8%), hormonal therapy (38.9%), systemic biologics (19.4%), intralesional triamcinolone (15.3%), isotretinoin (9.7%) and prednisone (1.4%). This study provides demographic and diagnostic information to characterize a pediatric cohort suffering from HS. In order to effectively treat patients with early-onset HS, one must consider the demographic information, disease progression, and comorbidities reflected in this population.