Pediatric Hidradenitis Suppurativa: Recognition and Risk Factors
What You Need to Know: Although the estimated prevalence of pediatric hidradenitis suppurativa is low, it remains under-recognized, leading to frequent delays in diagnosis.
Article summary
Investigators from McMaster University, Hamilton, and the University of Toronto, Ontario, Canada, conducted a metaanalysis to estimate the prevalence of hidradenitis suppurativa (HS), a chronic skin condition characterized by nodules and abscesses, typically in intertriginous areas, and clinical characteristics of pediatric patients with the condition. A standardized process was used to identify observational studies assessing children <18 years old with HS. Data collected from the selected studies included number of participants, location of study, patient demographic and clinical characteristics, and family history. Severity of HS in the included studies was graded as mild to severe, using Hurley stages. Results from the included studies were pooled using random effects meta-analysis. Studies conducted in the US were used to estimate the prevalence of HS in children.
A total of 37 articles that reported on 6,941 pediatric patients were included in the meta-analysis. After pooling data from 16 US studies, the prevalence of HS in children was estimated as 0.03% (95% confidence interval [CI], 0.01%, 0.05%). The age of patients was reported in 13 studies. The mean age at onset of symptoms was 11.3 years (95% CI, 10.15, 12.39), and mean age at diagnosis was 14.0 years (95% CI, 12.65, 15.28). Among 5,931 children included in 36 studies, 78.0% were females. Severity was reported in 1,469 patients, with 625 (42.6%) classified with mild HS (Hurley stage I), 679 (46.2%) with moderate severity (Hurley stage II), and 165 (11.2%) categorized as having severe HS (Hurley stage III). Among children included in 27 studies, 38% (95% CI, 30%, 45%) had a positive family history of HS.
Investigators’ conclusion: HS in children is uncommon and occurs predominantly in girls. The results suggest that the diagnosis is generally made more than 2 years after the onset of symptoms.
Commentary
Consistent with prior research, the current meta-analysis also highlights diagnostic delay as a significant concern. Early identification is essential as HS is most aggressive during the first 6 years after onset.2 Besides surgery, there are multiple treatment options available, including topical and systemic antibiotics, biologic agents, immunomodulators, and hormonal therapies.2 Nearly half of pediatric patients with HS already have scarring at the time of diagnosis, and timely treatment may prevent permanent tissue damage.2,3 The current study findings suggest that among females with a family history of HS, pediatricians should maintain a heightened index of suspicion and consider early referral for HS if concerning symptoms are identified.
Meghna Raphael, MD, FAAP, Houston, TX
Editorial Board Member, AAP Grand Rounds
Source article: Xiong G, Ali M, Kakhki EG, et al. Prevalence, age of onset, age at diagnosis, and family history of hidradenitis suppurativa in pediatric populations: a systematic review and meta-analysis. Pediatr Dermatol. 2025;42(6):1142-1148; doi: https://doi.org/10.1111/pde.70022.
