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Assessment of Pediatric Hidradenitis Suppurativa at a Regional Medical Center

Sarah N Rimmer, John Miller, India Hill, Claudia Leonardi, Deborah Hilton

Objective: Hidradenitis Suppurativa (HS) is a chronic, recurrent inflammatory disorder involving hair follicular occlusion, inflammation, and scarring. Few studies have been designed to characterize HS in pediatric patients. This retrospective study assessed the pediatric HS population at an academic medical center.
Methods: A retrospective chart review was performed of all encountersfor HS from April 2018 to July 2022 at Children’s Hospital in New Orleans, Louisiana. A total of 202 patients diagnosed with HS (ICD10=L73.2) were reviewed.
Results: Most patients identified as African American (72.4%). The mean age at HS onset was 12.1 years (SD: 1.9; range: 7-16); mean age of diagnosis was 13.0 years (SD: 1.9; range: 9-17). Family history of HS was not documented in 81.6% of pediatric patients. Pre-teen onset of disease (0-12 y) was recorded in 53.9% of patients. 50% of patients presented with Hurley stage I; 43.4%, stage II; and 6.6%, stage III. No association was found between Hurley stage at diagnosis and gender (p=0.610), race (p=0.603), or pre-teen onset (p=0.716). Eight patients were undergoing biologic therapy (infliximab, n=2; adalimumab, n=6), including 10.9% of females, 8.3% of males, 12.7% of African Americans, and 7.7% of Caucasians.
Conclusions: Family history is an important aspect of clinical history to ascertain in pediatric HS, as it is associated with early onset disease. Pediatric HS disproportionately affects non-Caucasian populations presenting with more severe disease. Cliniciansshould be aware of thistrend in caring for pediatric patients. 50% of patients on biologic therapy reported pre-teen onset of disease. In HS, early onset disease has been correlated with greater overall disease severity. Thus, more patients with early onset HS and likely moderate-to-severe disease will be initiated on biologic therapy in the future. It is crucial to detect pediatric HS in a timely manner, and counsel patients with pediatric HS on the possibility of biologic therapy.