More studies needed on procedural interventions in pediatric hidradenitis suppurativa

Key takeaways:

• Randomized controlled trials for procedural interventions are lacking in pediatric hidradenitis suppurativa patients.
• It is difficult to determine the efficacy of these procedures.

Higher-quality studies are needed to determine the efficacy of procedural interventions in pediatric hidradenitis suppurativa, according to a systematic review.

“Hidradenitis suppurativa (HS) is a painful, inflammatory skin disease that has historically

been understudied in the pediatric population,” Rahul Masson of the Keck School of Medicine of USC and colleagues wrote.

Comprehensive HS disease management may include several procedural interventions, including surgical excision, skin grafts and lasers. However, there is not much data on the use of such procedures in pediatric HS.

Masson and colleagues reviewed the Medline and Embase databases for articles investigating the efficacy and safety of these treatments in HS patients younger than 18 years.

The review yielded findings for 81 patients from 23 articles published between 1974 and 2021; 9.1% of patients had Hurley stage I, 36.4% had Hurley stage II and 54.5% had Hurley stage III.

The most commonly studied procedure was negative pressure wound therapy in 30 patients. Surgical excision with skin graft/flap was studied in 19 patients and endoscopic electrode or laser treatment in 11 patients.

Other findings for smaller cohorts of patients or case reports included approaches such as incision and drainage, deroofing, surgical excision, photodynamic therapy, cryoinsufflation and hyperbaric oxygen therapy.

While the researchers reported high response rates for many of the procedures, they noted that randomized controlled trials and cohort studies were rare. As a result, they said it is difficult to draw definitive conclusions about the efficacy of these procedures in younger populations.

“Randomized controlled trials, especially those geared toward minimally invasive procedural treatments, are needed to help guide clinicians on the most efficacious treatment modalities for pediatric patients with HS,” the researchers wrote.