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Pediatric hidradenitis suppurativa (HS) is underrecognized and can have a major impact on quality of life in young people. Given the condition's complexity, a multifaceted treatment approach including medication, surgery, and subspecialty care is often necessary.

The age of onset for pediatric HS is approximately 2 years. However, under-recognition leads to undertreatment, avoidable disease progression, and complications like scarring and contracture.

A review in was designed to identify and explore barriers that contribute to diagnostic delays, as well as the condition's impact on children and adolescents.

First author Colleen Cotton, MD, a pediatric dermatologist and researcher with Children's National Hospital in Washington, DC, discussed the study with the Reading Room. The exchange has been edited for length and clarity.

What key question did this report address?

Cotton: Nearly one-third of hidradenitis suppurativa cases occur in pediatric patients, and nearly half of patients endorse initial symptoms in childhood. The first 6 years of pediatric HS are typically the most severe, so there is an early window of opportunity for treating aggressively to avoid permanent damage. Thus, it is important to increase awareness of HS in primary care, urgent care, and emergency department settings.

To date, there have been few clinical studies and guidelines for pediatric HS. We reviewed the epidemiology, clinical presentation, comorbidities, and management of pediatric HS.

We had multiple goals in putting together this review. We are seeing more and more pediatric patients with HS. There is a knowledge gap among pediatricians about the pathophysiology and treatment options that are most appropriate, especially with the explosion of pediatric-specific research that has emerged in the last few years. We know that the longer it takes for patients to present for appropriate care, the more severe the disease can become.

We wanted to give pediatricians the opportunity to intervene and get these patients to a dermatologist early, understand the high burden of comorbidities in these patients, and recognize if patients may not be receiving the most up-to-date treatments.

It seems most of the data in the review come from studies of adults.

Cotton: At the time of publication of this review, there were no formal published clinical trials that included children or adolescents. Adolescent patients should be included as soon as possible in future trials of emerging therapies for HS. These patients can have moderate-to-severe disease, and including them in studies and access to medications is critical to improving outcomes.

What were the key findings or conclusions of the review?

Cotton: There is a window of opportunity for treating HS when medical therapies are more effective. Controlling the disease within this window is crucial.

There are few clinical studies or guidelines for pediatric HS, so many of our recommendations are based on expert opinion and extrapolation of adult data.

What are the takeaway messages?

Cotton: Children have psychiatric and somatic comorbidities at roughly the same rates as adults, and these should be screened for.

Pediatric patients with HS need to have their disease recognized early, and appropriate escalation of therapy is key to prevent scarring, tunnel formation, and disease progression.

Multimodal treatment including medical, surgical, and comorbidity management is also key. Clinicians should not miss the "window of opportunity," and should not be afraid to initiate systemic and/or biologic therapies early in the disease prior to tunnel formation. We also need to address quality-of-life issues including pain management and wound care.

In addition, educating patients and parents about the disease is vital to empowering them and increasing adherence. Our review contains a number of resources clinicians can share with families.