Diagnostic delays reported in pediatric hidradenitis suppurativa

Pediatric patients with hidradenitis suppurativa experienced delays in both diagnosis and treatment initiation, according to a study.

“Hidradenitis suppurativa (HS) in pediatric patients has been understudied,” Carmen Liy-Wong, MD, of the section of dermatology in the division of pediatric medicine at The Hospital for Sick Children at the University of Toronto, and colleagues wrote. “Increased awareness and recognition of HS prevalence in children demand efforts to better understand this condition.”

In the international, multicenter, retrospective analysis, the researchers aimed to more clearly define the demographics, clinical features, treatment, associated comorbidities and outcomes in HS. The medical record review yielded data for 481 patients with HS from dermatology clinics in Australia, Canada, Israel, Italy and the U.S. diagnosed between January 1996 and January 2017.

Eligible participants were aged 1 to 18 years. The study population was 80% girls, had a mean age at disease onset of 12.5 years and a mean age at diagnosis of 14.4 years. Researchers reported a family history of HS in 111 of 271 patients (41%).

Regarding clinical characteristics, 48% of patients had cysts or abscesses as the first signs or symptoms, while 25% initially experienced pain or tenderness, and 24% initially had papules or pustules.

Skin scarring was already evident at the first dermatologic assessment in 48% of patients.

Clinicians documented disease severity using Hurley staging in 60% of patients. Results showed that 47% of patients were classified as Hurley stage 1, 45% as stage 2 and 8% as stage 3.

A majority of the patient population (85%) experienced comorbid conditions. Obesity was the most commonly reported comorbidity (65%), followed by acne vulgaris (29%).

A comparably high proportion of patients experienced complications (79%), with scars or contractures being reported in 80% of those with complications.

“The findings of this study indicate that there is a gap in recognizing and diagnosing pediatric HS,” the researchers wrote. “Pediatric patients with HS are likely to present with other comorbidities.”