Increased hidradenitis suppurativa education needed to aid pediatric diagnosis, treatment

Greater training in hidradenitis suppurativa diagnosis and treatment in pediatric patients could lead to more effective management and fewer high-cost emergency department visits, according to a retrospective cohort study.

“Hidradenitis suppurativa (HS) is a chronic, inflammatory, follicular occlusive disease. It has an average onset at age 23 years and is reportedly rare in children, with an estimate that fewer than 2% of cases occur before age 11 years,” Katherine K. Hallock, MD, of the department of dermatology at Penn State Hershey Medical Center, Pennsylvania State University, and colleagues wrote in JAMA Dermatology. “Despite this, up to 50% of patients show symptoms between ages 10 and 21 years. Thus, HS is likely not rare in pediatric patients, but the estimates may reflect delays in seeking care, potential for misdiagnosis or underdiagnosing.”

The retrospective claims analysis used data from the IBM MarketScan database to identify patients with two or more claims for HS within 18 months. Those with their first claim before 18 years old were classified as pediatric patients with HS.

Of 8,727 subjects, 1,094 (12.5%) were pediatric and 7,633 (87.5%) were adults.

Pediatric patients were more likely to receive emergency department care (35.6% vs. 28.2%; P < .001) or urgent care (18.1% vs. 13.4%; P < .001) before diagnosis.

Pediatric patients were most likely to be seen by a pediatric clinician (81.7%), family medicine (66.5%) and dermatology department (39.8%) before diagnosis. Adults were most likely to be seen by family medicine (60.7%), internal medicine (39.5%) and gynecology departments (38.7%) before diagnosis.

Diagnoses of comedones (51% vs. 24.73%; P < .001) and folliculitis (27.15% vs. 13.64%; P < .001) were both more common in the pediatric cohort, while diagnoses of cellulitis, abscesses and furuncles were not significantly different between adult and pediatric patients.

The results highlight a need for practitioners of pediatrics, family medicine and emergency medicine to be more cognizant of HS diagnosis, according to the authors.

“These disciplines have the opportunity to promptly and accurately recognize and diagnose HS to initiate first-line management and referral to a dermatologist or other clinician who is experienced with HS,” they wrote. “Increased clinician education, improved screening measures for HS and coordination of care could lead to decreased diagnostic delay and more effective management of HS.”