ED providers need guidance in pediatric hidradenitis suppurativa treatment

Subtle gaps in knowledge among ED providers treating pediatric patients with hidradenitis suppurativa suggests a need for educational intervention, according to a study.

“Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory condition affecting between 1% to 4% of the population,” Raphaella A. Lambert, BA, of the University of Chicago Pritzker School of Medicine in Chicago, and Sarah L. Stein, MD, of the section of dermatology in the departments of medicine and pediatrics at the University of Chicago Medical Center, wrote. “Disease onset typically occurs in early adulthood and has been shown to be more common in African American or Black individuals and women; however, there is an increasing prevalence of HS in children and adolescents.”

Patients with HS tend to use ED services more than those with other inflammatory skin conditions. Furthermore, children with HS frequent the ED more than their adult counterparts, according to the researchers.

In this study, researchers evaluated the type of care pediatric patients with HS are receiving in the ED compared with HS management guidelines and the management of pediatric skin and soft tissue abscess (SSTA) patients.

The researchers conducted a retrospective chart review, and a total of 58 HS and 175 SSTA charts were analyzed. The pediatric patients (mean age, 14.71 years) were primarily girls (69.5%) and African American/Black individuals (93.6%).

Results showed that incision and drainage was the most common procedure for 108 patients with SSTA, which was a significant difference compared with the 17 patients with HS who had this procedure (P < .05). With incision and drainage being the “gold standard” for abscess management, the number of procedures in patients with HS may suggest that ED providers are hesitant to perform incisions for HS patients, according to the researchers. While this procedure does not improve HS outcomes, it can provide symptomatic relief, the researchers wrote.

Antibiotics and pain management medications were the most frequently prescribed drug types among both patients with HS and patients with SSTA, with clindamycin prescribed the most frequently (75.9% and 76%, respectively; P < .05). Further, among the total cohort, oral clindamycin was most common, prescribed to 62.1% of patients with HS and 70.1% of patients with SSTA.

According to the researchers, whereas current literature supports the use of oral clindamycin to treat adults with HS, in mild to moderate pediatric HS, pharmaceutical management guidelines “nearly unanimously” recommend a first intervention of topical clindamycin 1%.

Opiates were administered or prescribed significantly more frequently in patients with HS (19%) compared with patients with SSTA (6.9%), which the authors wrote is not recommended unless absolutely necessary due to the risk for addiction.

Lastly, dermatology consultations in the ED for both patients with HS and patients with SSTA were low at 3.4% and 0.6%, respectively. Also, ED providers referred 22.4% of patients with HS and 5.1% of patients with SSTA to dermatologists.

“Overall, our data suggest that ED providers may benefit from an educational initiative on the management of pediatric HS, particularly regarding procedural and pharmaceutical management,” Lambert and Stein wrote.

“Our work emphasizes the need for established clinical guidelines for the management of pediatric HS,” they concluded.