Efficacy of medical treatments for pediatric hidradenitis suppurativa: A systematic review

Abstract

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that has been insufficiently studied in the pediatric population. Timely and effective medical treatments may improve quality of life, mitigate disease burden, and prevent the need for invasive procedural interventions such as surgical excisions. However, there is a paucity of research on the efficacy of medical management strategies for HS in children and adolescents. The aim of this study was to perform a systematic review of the literature on the efficacy and safety of medical treatments for HS in patients <18 years of age. In April 2022, MEDLINE and EMBASE databases were searched for articles on the efficacy of medical treatments for HS in the pediatric population. Between 1984 and 2022, 35 articles (101 patients) met the inclusion criteria. Most patients had Hurley Stage II disease (46.7%, 35/75) followed by Stage I (36%, 27/75), and Stage III (17.3%, 13/75). 100% (23/23) of patients responded to antibiotics, 100% (8/8) to finasteride, 93.9% (31/33) to biologics, 80% (4/5) to oral retinoids, and 50% (6/12) to metformin. Overall, this study demonstrates that medical treatment regimens can improve HS symptoms in pediatric patients, but the extent of improvement is unclear, and the results were largely based on case reports or case series. Prospective studies are warranted to better understand the efficacy and safety of medical treatments for pediatric HS. Clinical trials of HS therapies need to be inclusive of pediatric patients to help define the optimal timing of treatment initiation and guide patient selection.

Hidradenitis suppurativa in children and young adults: a retrospective cross‐sectional observational study in the United Kingdom

“…13 Treatment options are typically extrapolated from treatment guidelines for adults, case reports, and personal experience. [8][9][10] Treatment was varied in this cohort, however, long courses of antibiotics, including combined therapy with rifampicin and clindamycin, were the mainstay of treatment. These findings are similar to management in the adult population.…”

“…6 Systemic immunomodulators are a developing treatment arm in the CYA HS population and adalimumab is currently approved in the treatment of moderate-severe HS in children aged 12 years and older. 9,10,14,15 This observational study aimed to detail the treatment patterns in a UK HS CYA group; further prospective therapeutic studies would be beneficial to better ascertain the optimal treatment options for the CYA HS population.…”

“…Treatment of HS in CYA populations lacks high‐quality evidence and there have been previous calls for specific guidelines for management 13 . Treatment options are typically extrapolated from treatment guidelines for adults, case reports, and personal experience 8–10 . Treatment was varied in this cohort, however, long courses of antibiotics, including combined therapy with rifampicin and clindamycin, were the mainstay of treatment.…”

“…8 Information on the demographics and management of the CYA HS population is limited with a paucity of evidence to serve as support for clinical decision making. 9 No previous observational studies have been carried out in a UK CYA HS population. This study was performed to gain further information on the demographics and management of HS in a UK CYA HS population.…”

“…Management of HS in the CYA population is based on treatments that are used for other pediatric indications and on data on their efficacy in adult HS patients 8 . Information on the demographics and management of the CYA HS population is limited with a paucity of evidence to serve as support for clinical decision making 9 . No previous observational studies have been carried out in a UK CYA HS population.…”