Hidradenitis suppurativa in the pediatric population

https://doi.org/10.1016/j.jaad.2015.07.051Get rights and content

Hidradenitis suppurativa (HS) generally appears after puberty, is infrequently seen in younger children, and early onset, which is associated with more widespread disease, is more common in children with a positive family history of HS. When compared with adults with HS, children with HS are more likely to have hormonal imbalances, making hormonal investigations integral to disease management in pediatric patients. HS affects intertriginous areas, presenting with double-ended comedones, tender subcutaneous nodules, purulent discharge, and the formation of sinus tracts, hypertrophic fibrotic scars, and dermal contractures. Treatment of HS in children has not been well studied. The goals of therapy in the pediatric setting are to alleviate pain, minimize inflammation and scarring, prevent disease progression, and postpone the need for surgery. Mild cases can be treated with topical antibiotics, while topical and oral antibiotics are the primary therapies for moderate forms of HS. Modalities like biologic agents, laser therapy, or surgery have been reserved for severe pediatric cases of HS. Early recognition and treatment are critical to minimize the effects of the disease on the life course. Given the significant impact of the condition on quality of life and self-esteem, there is a clear role for psychological support.

Section snippets

Hidradenitis suppurativa in the pediatric population

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disorder of the hair follicles that affects apocrine gland–bearing sites, such as the axillae and inguinal and perianal areas.1 HS is uncommon in children, with onset generally occurring well after puberty, typically between 20 and 24 years of age.1 Prepubertal onset—before 11 years of age—is estimated to occur in 2% of patients with HS.2, 3 A recent publication reported that 66 of 855 patients (7.7%) had an onset of disease

Approach to managing pediatric hidradenitis suppurativa

HS can have a significant impact on quality of life, lifestyle, and self-esteem.1, 2 Moreover, painful lesions can limit activity, school attendance, and exercise, thereby contributing to obesity, which in turn exacerbates HS.1, 2

The medical management of HS in children is particularly challenging because of the scarcity of research and data on long-term outcomes in pediatric populations with this condition.13, 14 Most of the data guiding management derive from small cases series, expert

References (21)

There are more references available in the full text version of this article.

Cited by (64)

  • Building a Multidisciplinary Hidradenitis Suppurativa Clinic

    2022, A Comprehensive Guide to Hidradenitis Suppurativa
  • Targeted Therapeutics: Biologics, Small Molecules

    2022, A Comprehensive Guide to Hidradenitis Suppurativa
  • Pediatric Hidradenitis Suppurativa

    2022, A Comprehensive Guide to Hidradenitis Suppurativa
  • Hidradenitis suppurativa in pediatric patients

    2022, Journal of the American Academy of Dermatology
    Citation Excerpt :

    Therefore, within the tetracycline class, doxycycline is the preferred antibiotic choice for pediatric HS patients. Other antibiotics such as the combination of clindamycin and rifampicin, ertapenem, erythromycin, and metronidazole are suitable for children.2,56,57 Rifampicin, however, should be used with caution in areas endemic for tuberculosis because of the risk of drug resistance.

View all citing articles on Scopus

This publication was supported through funding provided by AbbVie Corporation.

Conflicts of interest: None declared.

View full text