Pediatric-onset hidradenitis suppurativa: a case series of 42 patients

Introduction:
Hidradenitis suppurativa is a chronic, recurring skin condition characterized by inflammation of the terminal hair follicle. It presents as painful, deep-seated, inflamed lesions such as nodules, fistulas, and abscesses. While the mean onset age for hidradenitis suppurativa is typically between 21 and 29 years, the condition can also manifest in childhood.

Aim:
To review the clinical and demographic characteristics of pediatric-onset hidradenitis suppurativa patients.

Material and methods:
We present a case series of 42 patients with pediatric-onset hidradenitis suppurativa (onset age 0–18 years) and their management from two tertiary referral centres. Demographic, clinical, and laboratory data were assessed at the Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland, and the Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Poland, from January 2000 to May 2023. This report details the epidemiology, clinical course, and management of the reported pediatric-onset hidradenitis suppurativa cases.

Results:
The median age of onset in our patients was 14 years (range: 5–17). The cohort comprised 20 (48%) males and 22 (52%) females. The most frequent lesion locations were in the inguinal folds and armpits, with additional occurrences in the buttocks and lower abdomen. Common comorbidities included obesity, hypothyroidism, and affective disorders. The treatment regimen for most patients involved topical clindamycin, systemic antibiotics, oral retinoids, and surgical excisions. Additionally, biologic treatments such as adalimumab, infliximab, and secukinumab were administered.

Conclusions:
This study affirms that the clinical course and treatment methods in patients with pediatric-onset hidradenitis suppurativa are similar to the adult-onset form. Improved disease awareness enables earlier diagnosis, preventing the deterioration of skin lesions, a decrease in quality of life, and the onset of comorbidities, especially affective disorders, which are prevalent among patients with hidradenitis suppurativa.