Hidradenitis suppurativa in a cohort of overweight and obese children and adolescents

Abstract

Background Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurring disease mainly observed in adults. Obesity is considered an important independent factor in HS development and is associated with a higher prevalence of HS in children. We aimed to characterize the clinical presentation of HS in overweight and obese children and adolescents. Methods We performed a cross‐sectional observational study during January 2007–April 2015. Overweight and obese patients (5–17 years of age, BMI> 90th percentile) referred to The Children’s Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbæk, Denmark, underwent screening for dermatological conditions. A dermatologist ascertained the diagnosis of HS, and disease severity was assessed using Hurley staging and Sartorius score. Tobacco smoke exposure, body mass index (BMI) standard deviation score (SDS), and psychiatric comorbidities were recorded. Our cohort was compared with a reference cohort recruited in a previous study. Results A total of 195 children and adolescents underwent screening for dermatological conditions. Nine patients screened positive, and six of these patients were available for examination of whom five presented with HS. All HS cases were mild (median Sartorius score of 9). Four of the five patients (with varying constellations) reported tobacco exposure, a positive family history of HS, and exhibited psychiatric comorbidities. Conclusion Our findings support that the presence of pediatric HS is correlated with familial disposition to HS and psychiatric comorbidities.

Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature

“…Among the paediatric patients, only eight were males (12.1%). Even higher rates of familial occurrence were reported in a Danish cohort study of obese children (4/5, 80%) with a female to male ration of 3 : 2 3 …”

“…Furthermore, the disease course seems to be similar in paediatric patients and adults, with the exception of the Danish case series where all five patients experienced mild HS 1–3,11,25,26 …”

“…Regarding the disease onset, controversial data have been reported. While an onset before the age of 18 years was previously assessed in <2% of HS patients, more recent data suggested that 8% of patients show a disease onset before the age of 13.5 years 3,6,11,12 . A disease onset at prepubertal patients (10 years old or younger) with or without signs of precocious puberty or premature adrenarche has also been presented in case reports or small case series 4,13–17 …”

“…The pathophysiology of HS is not yet fully elucidated. Genetic susceptibility, obesity/metabolic syndrome and smoking are considered as promoting factors 1,3,4 . A positive family history has been associated with an early‐onset disease.…”

“…The disease presents usually after puberty, typically in the second and third decade of life, with a slight female predominance 1,3–5 . Prevalence of HS varies among different older studies from 0.00033 to 4%, 7–9 and a mean disease incidence of 6.0 per 100 000 person‐years has been reported 1 …”