Childhood hidradenitis suppurativa- An under-recognized entity

Patients with HS were defined by 2 or more claims for HS within 18 months as defined by International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10 codes. Patients were classified as pediatric HS if HS diagnosis occurred < 18 years and as adult HS if diagnosis was made at ≥ 18 years. Delay from HS onset to diagnosis was calculated by taking the difference from claims for an HS-related diagnosis to the first claim for HS.

Results

The study included 8727 members, comprising 1094 pediatric (155 male [14.2%] and 939 female patients [85.8%]

7633 adult patients (1748 men [22.9%] and 5885 women [77.1%]) were included in the study

The mean (SD) age of HS onset was 14.3 (2.5) years in the pediatric cohort and 37 (13) years in the adult cohort

Pediatric patients were likely to see other specialists, most commonly by pediatricians before diagnosis and commonly received diagnoses of folliculitis and comedones.

Pediatric patients with HS had high rates of comorbid skin and general medical conditions, including acne vulgaris (558 [51.0%]), acne conglobata (503 [45.9%]), obesity (369 [33.7%]), and anxiety disorders (367 [33.6%])

In the adult HS population, obesity (3343 [43.8%]), anxiety disorder (3216 [42.1%]), hyperlipidemia (2530 [33.1%]), and acne vulgaris (1888 [24.7%]) were the most common comorbidities.

A higher percentage of pediatric than adult patients had HS-specific claims for services rendered by emergency and urgent care physicians (35.6% vs 28.2%; P < .001; and 18.1% vs 13.4%; P < .001; respectively)

Adult patients were more likely to have inpatient stays (2.38% vs 4.22%; P = .002)

Pediatric patients had 2.24 emergency department (ED) claims per person, while adults had 3.5 claims per person

The mean cost per ED claim was similar between groups ($413.27 vs $682.54; P = .18).

The largest component of the total 5-year disease-specific cost was the cost of inpatient visits for pediatric and adult patients with HS

This study is one of the largest studies of children with HS till date. It showed that most children with HS are female with the mean age of symptom onset at 15 year. The female to male ratio for pediatric patients was higher than that observed in adult populations.

Thus this study highlights the importance of disciplines, such as pediatrics, family medicine, and emergency medicine, in diagnosis and management of HS and widens the horizon of dermatologist and non-dermatologists for improved recognition of HS in pediatric patients.

Source

Hallock KK, Mizerak MR, Dempsey A, Maczuga S, Kirby JS. Differences Between Children and Adults With Hidradenitis Suppurativa. JAMA Dermatol. 2021 Aug 11:e212865. doi: 10.1001/jamadermatol.2021.2865. Epub ahead of print. PMID: 34379074; PMCID: PMC8358812.