Hidradenitis suppurativa is a chronic inflammatory skin disorder primarily affecting apocrine gland-bearing areas, including the axillae, groin, and buttocks. It is reported in up to 2% of Western populations and with increasing incidence in children and adults. Nearly one-third of hidradenitis suppurativa cases occur in pediatric patients and nearly half of patients endorse initial symptoms in childhood. To date, there are few clinical studies and guidelines for pediatric hidradenitis suppurativa. Here, we review the epidemiology, clinical presentation, comorbidities, and management of pediatric hidradenitis suppurativa. We discuss barriers contributing to delays in diagnosis and the significant physical and emotional impact of the disease on children and adolescents.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating disease that primarily affects skin with apocrine glands. Painful nodules and abscesses occur with a predilection for skin folds and eventually form scarring. It was first described in 1833 as abscesses in the axillary, mammary, and perianal regions and was primarily treated surgically.1  In 1854, it was erroneously linked to sweat glands, which led to its name (from the Greek hydros for sweat and aden for glands).2,3  It was not until the 20th century that HS was proposed to be a primary inflammatory process of the apocrine glands.4,5  We are still elucidating the complete pathophysiology of HS.

Early identification of HS can be a challenge, as it relies on patients presenting with typical skin lesions, predilection for intertriginous sites, and recurrent flares of the disease.68  Waiting for the typical waxing and waning course in pediatric patients can delay diagnosis, and early disease is commonly missed or confused with infection.9  Many patients with pediatric HS (pedHS) present to emergency departments with disease flares that are managed with antibiotics or incision and drainage, and the diagnosis is not suspected.

Studies have shown that the gap between age of onset of disease and age at diagnosis of pedHS is nearly 2 years.10  Unfortunately, under-recognition leads to undertreatment, disease progression, and complications like scarring and contractures.10,11  The first 6 years of the disease are typically the most severe,6  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.

The exact prevalence of HS globally has been difficult to estimate because of misdiagnosis and diagnostic delay, though recent studies show rates between 0.1% and 2%.7,12  In the United States, the overall estimated point prevalence is 0.098%, with the highest prevalence of 0.17% in those aged 30 to 39 years.13  The prevalence of pedHS is estimated at 0.03%, but the point prevalence varies with age (0.11% in 15–17 year olds, 0.03% in 10–14 year olds, and 0.002% in those younger than 9 years).14  By far the highest prevalence is observed among female adolescents aged 15 to 17 years who are African American or biracial (0.53% and 0.25%, respectively).13,14 

HS was previously reported to occur most commonly between the ages of 20 and 24 years.15,16  Newer studies show a bimodal distribution, with the first peak in the late teens and the second in the mid-40s.17  Females experience earlier HS onset compared with males.17  Many adults report onset in childhood, with up to 50% of patients experiencing symptoms between 10 and 21 years of age.18 

It is estimated that 7% of patients with HS develop symptoms before 13 years old and 2% before 11 years old.19  Patients with early onset HS are twice as likely to report a positive family history of the disease and are more likely to be male.20,21  No studies have associated early onset HS with more severe disease. HS is a disorder with racial and ethnic disparities with higher incidence, prevalence, and severity in Blacks and Latinos.22,23  Yet the prevalence is likely underestimated because of delays in diagnosis and limited access to specialty care,21  possibly explaining why Blacks and Latinos are found to have more severe disease at presentation.

The pathophysiology of HS is complex. Smoking, obesity, friction, and different microorganisms are just a few of the inciting events believed to exacerbate the process of follicular occlusion and dilatation, subsequent follicular rupture with inflammatory response and cytokine activation, and profibrotic imbalance leading to sinus tracts and scarring in chronic HS.24 

Early HS lesions are associated with T helper type (Th) 1 and Th 17 inflammation.24  As the disease progresses, increased levels of interleukin (IL)-1, tumor necrosis factor (TNF), IL-17, S100 calcium-binding protein A9, caspase-1, and IL-10 have been reported in tissue and are supplemented by influx of neutrophils, monocytes, and mast cells.15  Dermal tunnels in chronic HS may be sources of inflammation, leading to increased expression of proinflammatory cytokines and chemokines like C-X-C motif chemokine ligand 1 (CXCL1) and CXCL8 that drive local and systemic neutrophilic infiltration.25  Additionally, imbalances in matrix metalloproteinases and tissue inhibitors of metalloproteinase increase profibrotic factors, including tissue growth factor-β 1, 2, and 3.24  This contributes to scarring and tunnel formation, hallmarks of HS.

Although HS is not a primary infection, the microbiome plays a role and superinfection is controversial. The microbiome in lesional and nonlesional skin of patients with HS differs significantly from healthy controls.26  Bacterial spread within intertriginous skin may boost immune activation.27  Distinct microbiological profiles have been identified in HS lesions depending on lesion type and severity.28  An intriguing new concept proposes that HS could be considered “autoinfectious” because of strictly cutaneous immune dysregulation led by the host microbiome.29  Further characterization of the microbiome in patients with pedHS is needed, as there may be differences from adults.

Sex hormones, particularly androgens, have been linked to the pathogenesis of HS.30  Support for hormonal involvement in disease pathophysiology includes the observations that females are predominantly affected and may experience premenstrual flares. HS also tends to improve during pregnancy, flare postpartum, and is often exacerbated by oral contraceptives with a low estrogen to progesterone ratio.31  Additionally, HS is rare before puberty or postmenopause, and can be the presenting feature of premature adrenarche.32  Children with HS may be more likely to have hormonal imbalances compared with adults.33  However, specific hormonal abnormalities or hyperandrogenism have not been demonstrated in patients with HS despite extensive study, suggesting androgen hypersensitivity may be more relevant locally at the level of the pilosebaceous unit.34 

A family history of HS has been reported in up to 41% of patients.10,35  Syndromic HS has been associated with autosomal dominant mutations in the γ-secretase complex genes (NCSTN, PSEN1, PSENEN, MEFV, POFUT1, PSTPIPP1, and FGFR2), though these mutations are rare in the general HS population.29,36  These variants were initially linked to Notch signaling, which plays an important role in follicular differentiation, keratinization, occlusion, and cyst formation, but no differential expression of Notch 1 through 4 has been identified in HS affected skin.37  Genetic factors linked with sporadic cases of HS are less understood and the focus of active research.

HS is predominantly a clinical diagnosis. Overall, its presentation in pediatric patients is similar to adult patients. Lesions include inflammatory nodules, abscesses, ulcers, comedones, sinus tracts, and variable types of scarring. Inflammatory nodules may be encapsulated or rupture with foul-smelling discharge, which may be mistaken for infection (Fig 1). Patients may have comedones, with double-headed comedones being pathognomonic for HS (Fig 2). Patients may also experience shallow, painful ulcers similar to cutaneous Crohn’s disease. In moderate to severe disease, tender, fluctuant abscesses or tunneling sinus tracts predominate. Sinus tracts consist of multiple interconnected tunnels and are almost always associated with scarring (Fig 3). Scarring includes atrophic or fish-mouth scars, hypertrophic, rope-like scars, and even contractures.

A multicenter review of 481 patients with pedHS reported that cyst or abscess (48%) and pain or tenderness (25%) were the most common signs at disease onset. Lesions at initial dermatologic assessment included cyst or abscess (49%), pustules or papules (49%), nodules (20%), double-headed comedones (23%), sinus tracts (10%), and ulcers (6%). The most commonly involved anatomic sites in pedHS are the axillae (75% to 85%), groin or inguinal folds (47% to 58%), and buttock (6% to 27%), and most patients have 1 to 2 body sites involved.10,21,38  Axillary involvement may be more likely to occur in males, whereas females have higher rates of groin involvement.39,40 

Almost half (48%) of patients with pedHS already have scarring at the time of initial presentation to dermatology.10  Although this may be confounded by the observation that patients with aggressive disease are more likely to seek medical care, clinicians should be prepared or even expect to treat aggressive disease in pediatric patients. Because of their age, pediatric patients are vulnerable to undertreatment, which may lead to scarring and significant psychosocial morbidity.

Delays in diagnosing pedHS are common, ranging from 0.7 to 2 years.10,16,41,42  A comparison of claims data showed that patients with pedHS were more likely to receive diagnoses of comedones and folliculitis than adults.16  It is not clear if this reflects a difference in how early pedHS presents or true misdiagnosis. Referrals to dermatology for HS are most commonly made by pediatricians (45%). Although emergency medicine accounts for only 5% of HS referrals, up to 22% of pediatric patients report visiting the emergency department and 8% have been hospitalized.10  Targeted educational interventions may improve delays in diagnosis.

The Hurley stage scoring system is commonly used to assess HS severity (no scoring systems used in adult HS studies are validated in pedHS). Hurley stage I encompasses single or multiple abscesses without sinus tracts or scarring. Hurley stage II describes single or multiple widely separated recurrent abscesses with sinus tract formation and scarring. Hurley stage III describes diffuse involvement with interconnected tracts and abscesses across the entire area.43  Between 35% and 53% of patients with pedHS present with Hurley stage II or III disease.10,42 

Hurley staging lacks quantitative and dynamic assessment over time. Other assessment tools exist, including the Sartorius scoring system, Hidradenitis Suppurativa Clinical Response, Hidradenitis Suppurativa Physician Global Assessment score, and International Hidradenitis Suppurativa Severity score system. A dynamic scoring system is important in pediatric patients, who may experience rapid progression of disease regardless of initial Hurley staging.41  Current clinical trials use Hurley stage and nodule counts for inclusion criteria, excluding many pediatric patients with moderate to severe disease.41  It will be important to consider how future trials can allow for greater enrollment of pediatric patients and better capture the dynamic course of HS.

Pediatricians must be aware of the wide range of comorbidities associated with pedHS. Estimated rates of comorbidities in pedHS range from 34% to 93%.10,44,45  Comorbidity rates from several large pedHS studies are summarized in Table 1. Although no validated guidelines exist for comorbidity screening in pedHS, there are some recommendations.34,44,46  Additional guidance can be extrapolated from recently published guidelines (Table 2).34,47 

Obesity is the strongest association with pedHS, with estimated obesity rates in patients with pedHS between 32.5% and 68.7%.10,16,38,42,44,4851  This risk was elevated regardless of sex, age, or race. However, many studies of pedHS examined BMI according to adult measures and not percentiles, potentially confounding the true rate of obesity in this population. Despite the association, there is minimal evidence demonstrating that weight reduction improves severity of disease.

Although metabolic syndrome is not well-defined in childhood, patients with pedHS are at risk for several of the individual diagnoses that define the syndrome.52  One retrospective case-control study of 153 pedHS patients showed a 12 times higher prevalence of metabolic syndrome compared with controls.45  Hyperlipidemia is seen at higher rates in pedHS (3.2% to 16%), though lower than reported in adults.10,16,44,49  Acanthosis nigricans, often a marker of hyperinsulinemia, was found in 17 of 73 pedHS patients in 1 study.44  Studies differ as to whether patients with pedHS have increased rates of hypertension.10,16,38,44,45,49,50,53 

In a retrospective study of 49 280 adults and 3042 children with HS, the percentage of children with a new diagnosis of depression (14%) was lower than adults (16.3%). However, the hazard ratio when compared with population rates for age was higher for pedHS (1.87) than adult HS (1.61).54  Another study of 25 adolescent patients with HS found a positive PHQ-2 depression screen in 32% of patients, more than double the rate seen in a general adolescent population.55 

Anxiety and other psychiatric disorders are also increased in pedHS. In a cross-sectional study of 87 053 155 US hospitalizations, HS accounted for 24 666 hospitalizations (899 pedHS) and was associated with a primary or secondary diagnosis of a mental health disorder (odds ratio 2.53).56  Estimated rates of these additional conditions range from 0% to 33.6% and vary by sample size, country, and study design.10,16,44,45,57  In a cohort of 153 patients with pedHS, the rate of a psychiatric comorbidity increased from 15.7% to 23.5% over 5 years, which was not seen with somatic comorbidities, highlighting the increased risk of developing psychiatric disorders after an HS diagnosis.45  Another study of 16 489 adults and children with HS also showed an increase in mood disorders after diagnosis, with Medicaid patients more likely to have psychiatric disorders than commercial or Medicare patients.53  Interestingly, in a study of 195 children from an obesity clinic, having a psychiatric comorbidity was associated with a pedHS diagnosis.58 

Recent studies have shown that prepubertal onset of pedHS is more common than once thought, with prevalence estimates ranging from 7.7% to 42.4%.20,21,39,42,59  PedHS was previously thought to be associated with precocious puberty or premature adrenarche based on case reports.32,6062  Although cases of precocious puberty and premature adrenarche are seen, they make up <5% of patients in multiple large pedHS studies.10,16,21,40,44,45 

Polycystic ovarian syndrome (PCOS) is seen with increased frequency in pedHS, with reported incidences in females of 0% to 17.5%.16,21,40,42,44,45  In 1 multidisciplinary PCOS clinic, 14 (15.2%) of 92 patients had concomitant HS.63  Rates of hirsutism (6.8% to 19.7%) and irregular menses (6.5% to 25.4%) may be even more frequent.40,42,44  Baseline screening for signs of PCOS and precocious puberty are recommended, but in the absence of these no hormonal workup is indicated.44,47 

Diabetes appears to be more common in pedHS (Table 1). One study of 73 patients with pedHS showed elevated rates of prediabetes (6.8%) and diabetes (type 1 and 2 combined, 2.7%), with males more likely to have prediabetes than females (21% and 3%, respectively).44  Another study of 58 patients in Asia found 17.2% with diabetes, with no difference between pediatric and adult onset HS.50  However, another study of 153 patients with pedHS showed no difference in rates of type 1 diabetes compared with controls, and no cases of type 2 diabetes.45 

Acne, dissecting cellulitis, and pilonidal cysts can occur with HS in an association called the follicular occlusion tetrad.64  Acne (13.7% to 68.8%), psoriasis (2.1% to 11%), and pyoderma gangrenosum (0.2% to 0.6%) are more common in pediatric patients with HS compared with other children.10,16,38,40,42,44,45  Severe pedHS is more likely to be associated with pilonidal cysts (4.1% to 16.4%).16,40,44  Patients should be seen by a dermatologist at least annually to screen for related skin conditions.47 

Down syndrome, or trisomy 21, is strongly associated with HS. Anywhere from 2% to 14% of patients with pedHS have Down syndrome and these patients have an earlier age of HS onset.10,12,40,42,44,45,6567  Patients with Down syndrome have higher overall rates of follicular occlusion disease, such as keratosis pilaris and folliculitis: 44.9% in 1 study of 243 pediatric dermatology patients with Down syndrome, and 38.9% in another study of 203 patients with Down syndrome.67,68  Regular screening for HS should be performed in all patients with Down syndrome. Partial or complete trisomy 136975  and keratitis-ichthyosis-deafness syndrome76,77  are also associated with pedHS.

Patients with pedHS should be screened for inflammatory bowel disease (IBD)34,47  as IBD occurs at higher rates in patients with pedHS than the general pediatric population (0.7% to 3.3%).10,16,45,78,79  In 1 study of 109 patients with pedHS, 48.6% had gastrointestinal symptoms, and 11.3% of those were diagnosed with IBD.78 Table 1 includes additional associations, including inflammatory arthritis, anemia, atopic dermatitis, and asthma.10,16,40,42,44,45,54 

Syndromic HS has also been reported in a subset of patients, typically in association with autoinflammatory disease.80,81  In these cases, HS may occur in conjunction with pyogenic or psoriatic arthritis, ankylosing spondylitis, pyoderma gangrenosum, and acne. These patients may respond to different therapies like IL-1 blockade.

PedHS has a massive impact on patients’ quality of life (QoL). Concerns regarding participation in sports, ability to shave, and judgment from peers are commonly reported.44  A QoL study of 25 patients with pedHS showed an average Skindex-Teen score of 45.7 (maximum 84, range 0–84), dramatically worse in comparison with patients with psoriasis (21.1) and atopic dermatitis (29.4).55,82  The most impactful factors were appearance of affected skin and feelings of frustration about HS. QoL worsened with Hurley stage. The Family Dermatology Life Quality Index was comparable to other inflammatory skin disorders, with the most impactful factors being time spent caring for their child with HS and personal emotional distress related to their child’s condition.55 

There are currently no formal published clinical studies that included children or adolescents. Management of pedHS is extrapolated from adult treatment patterns, and is based on clinical presentation, lesion type and location, and severity. Overall HS treatment data are limited by small sample size, inconsistent outcome measures, and lack of validated pedHS measures. This section is guided by the 2019 North American Clinical Management Guidelines for Hidradenitis Suppurativa and recent publications and supported by pediatric case series and case reports.83  A summary of recommended treatments for pediatric patients with HS is outlined in Figure 4, with detailed information on systemic treatments in Table 3. Treatments with no other pediatric indications or established pediatric safety data are not discussed. Management of associated comorbidities is beyond the scope of this review.

The lesions of HS can be quite painful. Use of acetaminophen or ibuprofen should be recommended when patients are flaring, with judicious use of opiates in exceptional cases. Patients may need to be excused from physical activities during flares.

Abscesses and sinus tracts are often associated with serous oozing, purulent drainage, and foul odor and can severely impact QoL. Therefore, appropriate wound care education and adequate, cost-effective wound care supplies are required, noting insurance coverage can be variable. Patients may benefit from absorbent foam, hydrogel, and nonadhesive gelling fiber dressings.84 

Topical Antimicrobial Agents

Benzoyl peroxide, chlorhexidine, and zinc pyrithione washes are commonly used daily to cleanse affected areas of HS to decrease microbial colonization. Potential irritation and bleaching of fabrics are common benzoyl peroxide side effects. Clindamycin 1% solution applied once or twice daily is used first-line for mild-to-moderate HS.85  It is often combined with benzoyl peroxide wash to minimize bacterial resistance. Alternately, resorcinol 15% cream daily may be employed for its antiseptic and keratolytic properties.40,86  Irritation and burning are possible side effects. Topical dapsone gel is supported by expert opinion only as clinical data are lacking.83 

Oral Antibiotics

For flares of HS, systemic antibiotic therapy is indicated. Tetracycline class antibiotics are used first-line because of their broad antibacterial coverage and anti-inflammatory action. Doxycycline is commonly used for mild-to-moderate HS over a 12-week course or as long-term maintenance if needed.83  Patients should be counseled on common side effects of photosensitivity, gastrointestinal upset, and rare hepatotoxicity. Alternately, minocycline can be employed in children 12 years and older. Potential side effects include dizziness, blue discoloration of skin or gums, and rare hepatotoxicity or drug hypersensitivity reactions.

Rifampin in combination with clindamycin systemically for 8 to 12 weeks is recommended for patients unresponsive to systemic tetracyclines.83  Fifteen percent of patients experienced nonspecific gastrointestinal upset; however, the risk of Clostridium difficile colitis should be considered. Systemic dapsone, a sulfone with anti-inflammatory properties, has been used second-line for refractory adult HS, with retrospective case series reporting ∼60% of patients achieving clinical improvement.87,88 

Intravenous Antibiotics

Based on limited case series, ertapenem, a broad-spectrum carbapenem antibiotic, is effective for severe flares in adult patients with HS.83,89 

Intralesional Corticosteroids

Triamcinolone acetonide intralesional injection has demonstrated efficacy for managing acute nodular HS lesions and can be used in willing pediatric patients.90  The addition of lidocaine 1% to injections can provide temporary anesthesia. Age-appropriate distraction techniques and topical lidocaine cream 30 minutes before injection may make the procedure more tolerable.

Biologic Therapy

A systematic review of biologic use in pedHS found that the mean duration of disease before initiating biologic treatment was 3.5 (±2.9) years.91  Most patients were Hurley stage 2. In the pooled analysis of 26 pedHS cases treated with biologics, 23.1% experienced complete resolution, 73.1% had partial response, and 3.8% had no improvement.91 

Adalimumab is a TNF-α inhibitor approved for use in patients aged 12 years and older with moderate-to-severe HS. Approval in the adolescent age group was based on adult studies without additional clinical trial data.92  Dosing is based on body weight. Other TNF-α inhibitors may be employed for refractory pedHS, including infliximab, a chimeric monoclonal antibody infusion. However, data on use of etanercept in HS are mostly nonsupportive.9395 

Side effects of TNF-α inhibitors include increased risk of opportunistic infections and reactivation of tuberculosis and hepatitis B.96  There is a small increased risk of malignancy, particularly lymphomas, made worse by concomitant use of immunosuppressants. Patients on TNF-α inhibitors (especially adalimumab) are at risk for autoimmunity with antidrug antibody formation and lupus-like reactions. Paradoxical exacerbation of HS has been reported with TNF-α inhibitor use.97 

IL-17a inhibitors (secukinumab, ixekizumab), approved for pediatric psoriasis, have been effective in limited adult HS case series.98,99  A systematic review of biologic use in pedHS reported limited cases of ustekinumab (IL-12/23 inhibitor) and anakinra (IL-1 inhibitor) treatment.91 

All patients should be tested for tuberculosis and hepatitis B before starting a biologic agent. All age-appropriate vaccines should be given 1 month before starting a biologic, and live vaccines should not be given to children on biologic therapy.100 

Hormonal Therapies

Hormonal therapies are used with increasing frequency in adolescents with HS; however, data are limited.101  Combined oral contraceptive pills are employed as adjunctive therapy in female patients with HS. Progestins with greater antiandrogenic activity (ie, norgestimate, drospirenone) are recommended. Data suggest that patients with perimenstrual flares of HS and those on concomitant treatments respond better than patients without cyclical flares or on combined oral contraceptive monotherapy.102  Before starting a combined oral contraceptive, patients should be appropriately screened for blood clot and stroke risk, hypertension, migraine with aura, and liver tumor. Note that rifampin will decrease the efficacy of combined oral contraceptives.103 

Spironolactone, an antiandrogen and potassium-sparing diuretic, may be used alone or in combination with combined oral contraceptives in postmenarchal females with HS. Side effects include menstrual irregularity and breast tenderness. Hyperkalemia may result, primarily in those with renal dysfunction; however, serum potassium monitoring is not required for otherwise healthy patients.104 

Finasteride, a systemic 5α-reductase inhibitor, has been used in adults and children with HS unresponsive to or intolerant of other antiandrogens.105  Potential side effects include headache, dizziness, nausea, breast tenderness, gynecomastia, and menstrual irregularity. Metformin decreases hepatic glucose production and is an antiandrogen. It is an adjunctive therapy predominantly used in patients with HS and associated hyperinsulinemia.106  Potential side effects include gastrointestinal upset, decreased absorption of vitamin B12, and lactic acidosis.

Retinoids

Isotretinoin has demonstrated variable efficacy in limited retrospective and prospective studies for HS.107109  Typical dosing is 0.5 to 1.0 mg/kg per day. Because of its teratogenicity, isotretinoin is subject to a mandatory US Food and Drug Administration risk management program (iPLEDGE) for all patients in the United States. Acitretin, also a teratogen, should be used with extreme caution in patients of childbearing potential because of its prolonged half-life. Other retinoid side effects include cheilitis, hyperlipidemia, transaminitis, and rare pancreatitis. Because of pseudotumor cerebri risk, isotretinoin should not be used with systemic tetracyclines.

Systemic Immunomodulators

Systemic corticosteroids, 0.5 to 1.0 mg/kg per day, are used for 7 to 10 days to control flares of HS and serve as a bridge to other systemic therapy.83 

Combination therapy utilizing cyclosporine with adalimumab has been reported in adult patients with severe HS.110  Side effects of cyclosporine include immunosuppression, kidney damage, hypertension, and decreased cell counts; therefore, close clinical and laboratory monitoring is required. Based on adult case series, colchicine 0.5 mg twice daily is used as adjunctive therapy most commonly with systemic tetracyclines.111  Methotrexate and azathioprine are not recommended for HS.83 

Surgical Management

When the recurrent lesions of HS form scars and sinus tracts, surgical intervention may be required. Incision and drainage should only be performed for painful, acute disease with grossly purulent abscesses. It is not recommended as definitive therapy because of high recurrence rates. Other surgical techniques, like punch debridement (for small nodules) or a tissue sparing deroofing procedure (for epithelialized tracts), can be performed in both the acute and chronic setting with careful attention to pain control.112  Larger areas of severe, chronic disease may require wide local excision with the potential need for skin grafts or flaps. Depending on the patient’s age and extent of the surgical procedure chosen, these may be done under local or general anesthesia by an experienced pediatric, plastic, or dermatologic surgeon.

Laser hair removal utilizing long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) or alexandrite lasers may be useful in patients with mild-to-moderate HS. Multiple treatments are required; they are moderately painful and may not be covered by insurance, so appropriate patient selection is needed. In a prospective study of 20 adults with mild-to-moderate HS treated with alexandrite laser compared with 20 untreated matched control patients, treated patients reported decreased pain, improved QoL metrics, and longer flare-free periods at 15 and 30 weeks.113 

Botulinum toxin A injections to reduce sweating in the axillae and groin have been reported to be beneficial in small case series and case reports in both pediatric and adult patients with HS, particularly those with associated hyperhidrosis.114 

HS is a chronic condition with long-term health implications. Educating patients and parents about the disease is vital to empowering them and increasing adherence. Table 5 lists resources for families.

PedHS is an underrecognized inflammatory disease with tremendous impact on QoL during an important time in development. With a high burden of comorbidities and variable treatment options, multimodal management with medications, surgery, and multiple subspecialists is often necessary for more advanced disease. Early recognition and intervention allow clinicians to act during a window of opportunity where treatments are more effective.

Dr Cotton conceptualized and designed the study, performed the initial literature review, and drafted the initial manuscript; Drs Lara-Corrales, Chen, and Hussain drafted portions of the initial manuscript; Dr Zaenglein conceptualized and designed the study, and drafted portions of the initial manuscript; and all authors critically reviewed and revised the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

FUNDING: This project was supported by the Pediatric Dermatology Research Alliance (PeDRA).

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

HS

hidradenitis suppurativa

IBD

inflammatory bowel disease

IL

interleukin

PCOS

polycystic ovarian syndrome

pedHS

pediatric hidradenitis suppurativa

QoL

Quality of life

TNF

tumor necrosis factor

1
Velpeau
A
.
Dictionnaire de medecine, un repertoire general des sciences medicales sous la rapport theorique et practique
. In:
Aisselle
.
Vol. 2
. 2nd ed.
Paris, France
:
Bechet Jeune
;
1833
2
Verneuil
A
.
Etudes sur les tumeurs de la peau; des quelques maladies des glandes sudoriparies
.
Arch Gen Med
.
1854
;
5
(
4
):
447
468
3
Verneuil
A
.
De l’hidrosadenite phlegmoneuse et des abces sudoripares
.
Arch Gen Med
.
1864
;
2
:
537
557
4
Brunsting
HA
.
Hidradenitis suppurativa; abscess of the apocrine sweat glands
.
Arch Derm Syphilol
.
1939
;
39
:
108
120
5
Shelley
WB
,
Cahn
MM
.
The pathogenesis of hidradenitis suppurativa in man
.
Arch Dermatol
.
1955
;
72
(
6
):
562
565
6
Von Der Werth
JM
,
Williams
HC
,
Raeburn
JA
.
The clinical genetics of hidradenitis suppurativa revisited
.
Br J Dermatol
.
2000
;
142
(
5
):
947
953
7
Alikhan
A
,
Sayed
C
,
Alavi
A
, et al
.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management
.
J Am Acad Dermatol
.
2019
;
81
(
1
):
76
90
8
Zouboulis
CC
,
Del Marmol
V
,
Mrowietz
U
,
Prens
EP
,
Tzellos
T
,
Jemec
GB
.
Hidradenitis suppurativa/acne inversa: criteria for diagnosis, severity assessment, classification and disease evaluation
.
Dermatology
.
2015
;
231
(
2
):
184
190
9
Kittler
NW
,
Williams
JC
,
Kudlinski
MV
, et al
.
Evaluation of hidradenitis suppurativa diagnostic criteria in pediatric patients
.
JAMA Dermatol
.
2022
;
158
(
12
):
1404
1408
10
Liy-Wong
C
,
Kim
M
,
Kirkorian
AY
, et al
.
Hidradenitis suppurativa in the pediatric population: an international, multicenter, retrospective, cross-sectional study of 481 pediatric patients
.
JAMA Dermatol
.
2021
;
157
(
4
):
385
391
11
Calao
M
,
Wilson
JL
,
Spelman
L
, et al
.
Hidradenitis suppurativa (HS) prevalence, demographics and management pathways in Australia: a population-based cross-sectional study
.
PLoS One
.
2018
;
13
(
7
):
e0200683
12
Ingram
JR
,
Jenkins-Jones
S
,
Knipe
DW
,
Morgan
CLI
,
Cannings-John
R
,
Piguet
V
.
Population-based clinical practice research datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa
.
Br J Dermatol
.
2018
;
178
(
4
):
917
924
13
Garg
A
,
Kirby
JS
,
Lavian
J
,
Lin
G
,
Strunk
A
.
Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States
.
JAMA Dermatol
.
2017
;
153
(
8
):
760
764
14
Garg
A
,
Wertenteil
S
,
Baltz
R
,
Strunk
A
,
Finelt
N
.
Prevalence estimates for hidradenitis suppurativa among children and adolescents in the United States: a gender- and age-adjusted population analysis
.
J Invest Dermatol
.
2018
;
138
(
10
):
2152
2156
15
Saunte
DML
,
Jemec
GBE
.
Hidradenitis suppurativa: advances in diagnosis and treatment
.
JAMA
.
2017
;
318
(
20
):
2019
2032
16
Hallock
KK
,
Mizerak
MR
,
Dempsey
A
,
Maczuga
S
,
Kirby
JS
.
Differences between children and adults with hidradenitis suppurativa
.
JAMA Dermatol
.
2021
;
157
(
9
):
1095
1101
17
Naik
HB
,
Paul
M
,
Cohen
SR
,
Alavi
A
,
Suàrez-Fariñas
M
,
Lowes
MA
.
Distribution of self-reported hidradenitis suppurativa age at onset
.
JAMA Dermatol
.
2019
;
155
(
8
):
971
973
18
Molina-Leyva
A
,
Cuenca-Barrales
C
.
Adolescent-onset hidradenitis suppurativa: prevalence, risk factors and disease features
.
Dermatology
.
2019
;
235
(
1
):
45
50
19
Scheinfeld
N
.
Hidradenitis suppurativa in prepubescent and pubescent children
.
Clin Dermatol
.
2015
;
33
(
3
):
316
319
20
Deckers
IE
,
van der Zee
HH
,
Boer
J
,
Prens
EP
.
Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement
.
J Am Acad Dermatol
.
2015
;
72
(
3
):
485
488
21
Braunberger
TL
,
Nicholson
CL
,
Gold
L
, et al
.
Hidradenitis suppurativa in children: the Henry Ford experience
.
Pediatr Dermatol
.
2018
;
35
(
3
):
370
373
22
Shao
K
,
Hooper
J
,
Feng
H
.
Racial and ethnic health disparities in dermatology in the United States. Part 2: disease-specific epidemiology, characteristics, management, and outcomes
.
J Am Acad Dermatol
.
2022
;
87
(
4
):
733
744
23
Cullen
MR
,
Lemeshow
AR
,
Russo
LJ
,
Barnes
DM
,
Ababio
Y
,
Habtezion
A
.
Disease-specific health disparities: a targeted review focusing on race and ethnicity
.
Healthcare (Basel)
.
2022
;
10
(
4
):
603
24
Vossen
ARJV
,
van der Zee
HH
,
Prens
EP
.
Hidradenitis suppurativa: a systematic review integrating inflammatory pathways into a cohesive pathogenic model
.
Front Immunol
.
2018
;
9
:
2965
25
Navrazhina
K
,
Frew
JW
,
Gilleaudeau
P
,
Sullivan-Whalen
M
,
Garcet
S
,
Krueger
JG
.
Epithelialized tunnels are a source of inflammation in hidradenitis suppurativa
.
J Allergy Clin Immunol
.
2021
;
147
(
6
):
2213
2224
26
Ring
HC
,
Thorsen
J
,
Saunte
DM
, et al
.
The follicular skin microbiome in patients with hidradenitis suppurativa and healthy controls
.
JAMA Dermatol
.
2017
;
153
(
9
):
897
905
27
Sabat
R
,
Jemec
GBE
,
Matusiak
Ł
,
Kimball
AB
,
Prens
E
,
Wolk
K
.
Hidradenitis suppurativa
.
Nat Rev Dis Primers
.
2020
;
6
(
1
):
18
28
Guet-Revillet
H
,
Coignard-Biehler
H
,
Jais
JP
, et al
.
Bacterial pathogens associated with hidradenitis suppurativa, France
.
Emerg Infect Dis
.
2014
;
20
(
12
):
1990
1998
29
Zouboulis
CC
,
Benhadou
F
,
Byrd
AS
, et al
.
What causes hidradenitis suppurativa? -15 years after
.
Exp Dermatol
.
2020
;
29
(
12
):
1154
1170
30
Karagiannidis
I
,
Nikolakis
G
,
Zouboulis
CC
.
Endocrinologic aspects of hidradenitis suppurativa
.
Dermatol Clin
.
2016
;
34
(
1
):
45
49
31
Stellon
AJ
,
Wakeling
M
.
Hidradenitis suppurativa associated with use of oral contraceptives
.
BMJ
.
1989
;
298
(
6665
):
28
29
32
Lewis
F
,
Messenger
AG
,
Wales
JK
.
Hidradenitis suppurativa as a presenting feature of premature adrenarche
.
Br J Dermatol
.
1993
;
129
(
4
):
447
448
33
Liy-Wong
C
,
Pope
E
,
Lara-Corrales
I
.
Hidradenitis suppurativa in the pediatric population
.
J Am Acad Dermatol
.
2015
;
73
(
5 suppl 1
):
S36
S41
34
Choi
E
,
Ooi
XT
,
Chandran
NS
.
Hidradenitis suppurativa in pediatric patients
.
J Am Acad Dermatol
.
2022
;
86
(
1
):
140
147
35
Goldburg
SR
,
Strober
BE
,
Payette
MJ
.
Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis
.
J Am Acad Dermatol
.
2020
;
82
(
5
):
1045
1058
36
Ingram
JR
.
The genetics of hidradenitis suppurativa
.
Dermatol Clin
.
2016
;
34
(
1
):
23
28
37
Frew
JW
,
Navrazhina
K
.
No evidence that impaired Notch signaling differentiates hidradenitis suppurativa from other inflammatory skin diseases
.
Br J Dermatol
.
2020
;
182
(
4
):
1042
1043
38
Vaiopoulos
AG
,
Nikolakis
G
,
Zouboulis
CC
.
Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature
.
J Eur Acad Dermatol Venereol
.
2020
;
34
(
9
):
2140
2146
39
Seivright
J
,
Collier
E
,
Grogan
T
, et al
.
Pediatric hidradenitis suppurativa: epidemiology, disease presentation, and treatments
.
J Dermatolog Treat
.
2022
;
33
(
4
):
2391
2393
40
Riis
PT
,
Saunte
DM
,
Sigsgaard
V
, et al
.
Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients
.
Arch Dermatol Res
.
2020
;
312
(
10
):
715
724
41
Bui
H
,
Sayed
C
.
A cross-sectional study of pediatric hidradenitis suppurativa and the value of the International Hidradenitis Suppurativa Severity Score System (IHS4) as a pediatric clinical trial inclusion criteria
.
Pediatr Dermatol
.
2022
;
39
(
5
):
689
694
42
Garcovich
S
,
Fania
L
,
Caposiena
D
, et al
.
Pediatric hidradenitis suppurativa: a cross-sectional study on clinical features and treatment approaches
.
J Cutan Med Surg
.
2022
;
26
(
2
):
127
134
43
Hurley
HJ
.
Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa and familial benign pemphigus: surgical approach
. In:
Roenigk
RK
,
Roenigk
HH
Jr
, eds.
Dermatologic Surgery: Principles and Practice
, 2nd ed.
New York, NY
:
Marcel Dekker
;
1996
:
623
645
44
Seivright
JR
,
Collier
E
,
Grogan
T
,
Hogeling
M
,
Shi
VY
,
Hsiao
JL
.
Physical and psychosocial comorbidities of pediatric hidradenitis suppurativa: a retrospective analysis
.
Pediatr Dermatol
.
2021
;
38
(
5
):
1132
1136
45
Tiri
H
,
Jokelainen
J
,
Timonen
M
,
Tasanen
K
,
Huilaja
L
.
Somatic and psychiatric comorbidities of hidradenitis suppurativa in children and adolescents
.
J Am Acad Dermatol
.
2018
;
79
(
3
):
514
519
46
Toledo
I
,
Lee
SS
,
Park
HH
,
Vuong
C
,
Conic
RRZ
,
Hightower
GK
.
A visit guide for adolescent hidradenitis suppurativa: bridging the divide between pediatric and adult care
.
JAAD Int
.
2022
;
6
:
84
85
47
Garg
A
,
Malviya
N
,
Strunk
A
, et al
.
Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations
.
J Am Acad Dermatol
.
2022
;
86
(
5
):
1092
1101
48
Balgobind
A
,
Finelt
N
,
Strunk
A
,
Garg
A
.
Association between obesity and hidradenitis suppurativa among children and adolescents: a population-based analysis in the United States
.
J Am Acad Dermatol
.
2020
;
82
(
2
):
502
504
49
Edigin
E
,
Eseaton
PO
.
A report of 1290 pediatric hidradenitis suppurativa hospitalizations: a nationwide analysis from the Kids’ Inpatient Database
.
J Am Acad Dermatol
.
2022
;
86
(
6
):
1446
1449
50
Choi
E
,
Cook
AR
,
Chandran
NS
.
Hidradenitis suppurativa: an Asian perspective from a Singaporean institute
.
Skin Appendage Disord
.
2018
;
4
(
4
):
281
285
51
Reichert
B
,
Fernandez Faith
E
,
Harfmann
K
.
Weight counseling in pediatric hidradenitis suppurativa patients
.
Pediatr Dermatol
.
2020
;
37
(
3
):
480
483
52
Magge
SN
,
Goodman
E
,
Armstrong
SC
;
Committee on Nutrition
;
Section on Endocrinology
;
Section on Obesity
.
The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering
.
Pediatrics
.
2017
;
140
(
2
):
e20171603
53
Marvel
J
,
Vlahiotis
A
,
Sainski-Nguyen
A
,
Willson
T
,
Kimball
A
.
Disease burden and cost of hidradenitis suppurativa: a retrospective examination of US administrative claims data
.
BMJ Open
.
2019
;
9
(
9
):
e030579
54
Wright
S
,
Strunk
A
,
Garg
A
.
New-onset depression among children, adolescents, and adults with hidradenitis suppurativa
.
J Am Acad Dermatol
.
2020
;
83
(
5
):
1360
1366
55
McAndrew
R
,
Lopes
FCPS
,
Sebastian
K
,
Diaz
LZ
.
Quality of life in hidradenitis suppurativa: a cross-sectional study of a pediatric population
.
J Am Acad Dermatol
.
2021
;
84
(
3
):
829
830
56
Patel
KR
,
Rastogi
S
,
Singam
V
,
Lee
HH
,
Amin
AZ
,
Silverberg
JI
.
Association between hidradenitis suppurativa and hospitalization for psychiatric disorders: a cross-sectional analysis of the National Inpatient Sample
.
Br J Dermatol
.
2019
;
181
(
2
):
275
281
57
Shavit
E
,
Dreiher
J
,
Freud
T
,
Halevy
S
,
Vinker
S
,
Cohen
AD
.
Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa
.
J Eur Acad Dermatol Venereol
.
2015
;
29
(
2
):
371
376
58
Lindsø Andersen
P
,
Kromann
C
,
Fonvig
CE
,
Theut Riis
P
,
Jemec
GBE
,
Holm
JC
.
Hidradenitis suppurativa in a cohort of overweight and obese children and adolescents
.
Int J Dermatol
.
2020
;
59
(
1
):
47
51
59
Bettoli
V
,
Ricci
M
,
Zauli
S
,
Virgili
A
.
Hidradenitis suppurativa-acne inversa: a relevant dermatosis in paediatric patients
.
Br J Dermatol
.
2015
;
173
(
5
):
1328
1330
60
Jourdain
JC
,
Le Lorier
B
,
Mourier
C
,
Ploussard
JP
,
Roussel
F
.
Virilization caused by 21-hydroxylase deficiency and axillary sweat gland hyperplasia [in French]
.
Ann Dermatol Venereol
.
1988
;
115
(
11
):
1136
1138
61
Palmer
RA
,
Keefe
M
.
Early-onset hidradenitis suppurativa
.
Clin Exp Dermatol
.
2001
;
26
(
6
):
501
503
62
Mengesha
YM
,
Holcombe
TC
,
Hansen
RC
.
Prepubertal hidradenitis suppurativa: two case reports and review of the literature
.
Pediatr Dermatol
.
1999
;
16
(
4
):
292
296
63
Torres-Zegarra
C
,
Sundararajan
D
,
Benson
J
, et al
.
Care for adolescents with polycystic ovary syndrome: development and prescribing patterns of a multidisciplinary clinic
.
J Pediatr Adolesc Gynecol
.
2021
;
34
(
5
):
617
625
64
Kimball
AB
,
Sundaram
M
,
Gauthier
G
, et al
.
The comorbidity burden of hidradenitis suppurativa in the United States: a claims data analysis
.
Dermatol Ther (Heidelb)
.
2018
;
8
(
4
):
557
569
65
Giovanardi
G
,
Chiricozzi
A
,
Bianchi
L
, et al
.
Hidradenitis suppurativa associated with Down syndrome is characterized by early age at diagnosis
.
Dermatology
.
2018
;
234
(
1-2
):
66
70
66
Denny
G
,
Anadkat
MJ
.
Hidradenitis suppurativa (HS) and Down syndrome (DS): increased prevalence and a younger age of hidradenitis symptom onset
.
J Am Acad Dermatol
.
2016
;
75
(
3
):
632
634
67
Rork
JF
,
McCormack
L
,
Lal
K
,
Wiss
K
,
Belazarian
L
.
Dermatologic conditions in Down syndrome: a single-center retrospective chart review
.
Pediatr Dermatol
.
2020
;
37
(
5
):
811
816
68
Firsowicz
M
,
Boyd
M
,
Jacks
SK
.
Follicular occlusion disorders in Down syndrome patients
.
Pediatr Dermatol
.
2020
;
37
(
1
):
219
221
69
Forconi
R
,
Bigoni
S
,
Pacetti
L
, et al
.
The link between hidradenitis suppurativa and phylloid hypomelanosis in partial trisomy-13 mosaicism: new evidences and further genetic/pathogenetic insights
.
Pediatr Dermatol
.
2021
;
38
(
3
):
637
639
70
González-Enseñat
MA
,
Vicente
A
,
Poo
P
, et al
.
Phylloid hypomelanosis and mosaic partial trisomy 13: two cases that provide further evidence of a distinct clinicogenetic entity
.
Arch Dermatol
.
2009
;
145
(
5
):
576
578
71
Faletra
F
,
Berti
I
,
Tommasini
A
, et al
.
Phylloid pattern of hypomelanosis closely related to chromosomal abnormalities in the 13q detected by SNP array analysis
.
Dermatology
.
2012
;
225
(
4
):
294
297
72
Keyes
E
,
Larijani
M
,
Castelo-Soccio
L
,
Treat
JR
.
Severe recalcitrant hidradenitis suppurativa in a 2-year-old boy with partial trisomy 13
.
Pediatr Dermatol
.
2022
;
39
(
3
):
491
493
73
Tabata
N
,
Togashi
N
.
Hidradenitis suppurativa in a long-lived patient with trisomy 13
.
JAAD Case Rep
.
2020
;
6
(
6
):
528
530
74
Torrelo
A
,
Fernandez-Crehuet
P
,
Del Prado
E
, et al
.
Extensive comedonal and cystic acne in Patau syndrome
.
Pediatr Dermatol
.
2010
;
27
(
2
):
199
200
75
Inoue
CN
,
Tanaka
Y
,
Tabata
N
.
Acne conglobata in a long-term survivor with trisomy 13, accompanied by selective IgM deficiency
.
Am J Med Genet A
.
2017
;
173
(
7
):
1903
1906
76
Montgomery
JR
,
White
TW
,
Martin
BL
,
Turner
ML
,
Holland
SM
.
A novel connexin 26 gene mutation associated with features of the keratitis-ichthyosis-deafness syndrome and the follicular occlusion triad
.
J Am Acad Dermatol
.
2004
;
51
(
3
):
377
382
77
Bettoli
V
,
Forconi
R
,
Pezzini
I
, et al
.
KID Syndrome and hidradenitis suppurativa: a rare association responding to surgical treatment
.
Skin Appendage Disord
.
2021
;
7
(
1
):
21
24
78
Lloyd-McLennan
AM
,
Ali
S
,
Kittler
NW
.
Prevalence of inflammatory bowel disease among pediatric patients with hidradenitis suppurativa and the potential role of screening with fecal calprotectin
.
Pediatr Dermatol
.
2021
;
38
(
1
):
98
102
79
Natarajan
B
,
Sauer
C
,
Shehata
B
,
Kugathasan
S
.
Hidradenitis suppurativa and pediatric Crohn disease
.
J Pediatr Gastroenterol Nutr
.
2015
;
60
(
4
):
e29
e30
80
Garcovich
S
,
Genovese
G
,
Moltrasio
C
,
Malvaso
D
,
Marzano
AV
.
PASH, PAPASH, PsAPASH, and PASS: the autoinflammatory syndromes of hidradenitis suppurativa
.
Clin Dermatol
.
2021
;
39
(
2
):
240
247
81
Gasparic
J
,
Theut Riis
P
,
Jemec
GB
.
Recognizing syndromic hidradenitis suppurativa: a review of the literature
.
J Eur Acad Dermatol Venereol
.
2017
;
31
(
11
):
1809
1816
82
Smidt
AC
,
Lai
JS
,
Cella
D
,
Patel
S
,
Mancini
AJ
,
Chamlin
SL
.
Development and validation of Skindex-Teen, a quality-of-life instrument for adolescents with skin disease
.
Arch Dermatol
.
2010
;
146
(
8
):
865
869
83
Alikhan
A
,
Sayed
C
,
Alavi
A
, et al
.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management
.
J Am Acad Dermatol
.
2019
;
81
(
1
):
91
101
84
Schneider
C
,
Sanchez
DP
,
MacQuhae
F
,
Stratman
S
,
Lev-Tov
H
.
Wound dressings improve quality of life for hidradenitis suppurativa patients
.
J Am Acad Dermatol
.
2022
;
86
(
2
):
450
453
85
Clemmensen
OJ
.
Topical treatment of hidradenitis suppurativa with clindamycin
.
Int J Dermatol
.
1983
;
22
(
5
):
325
328
86
Molinelli
E
,
Brisigotti
V
,
Simonetti
O
, et al
.
Efficacy and safety of topical resorcinol 15% as long-term treatment of mild-to-moderate hidradenitis suppurativa: a valid alternative to clindamycin in the panorama of antibiotic resistance
.
Br J Dermatol
.
2020
;
183
(
6
):
1117
1119
87
Murray
G
,
Hollywood
A
,
Kirby
B
,
Hughes
R
.
Dapsone therapy for hidradenitis suppurativa
.
Br J Dermatol
.
2020
;
183
(
4
):
767
768
88
López-Llunell
C
,
Riera-Martí
N
,
Gamissans
M
,
Romaní
J
.
Dapsone in hidradenitis suppurativa: a case series of 56 patients
.
Dermatol Ther (Heidelb)
.
2021
;
34
(
6
):
e15161
89
Braunberger
TL
,
Nartker
NT
,
Nicholson
CL
, et al
.
Ertapenem - a potent treatment for clinical and quality of life improvement in patients with hidradenitis suppurativa
.
Int J Dermatol
.
2018
;
57
(
9
):
1088
1093
90
Cuenca-Barrales
C
,
Montero-Vílchez
T
,
Sánchez-Díaz
M
, et al
.
Intralesional treatments in hidradenitis suppurativa: a systematic review
.
Dermatology
.
2022
;
238
(
6
):
1084
1091
91
Sachdeva
M
,
Kim
P
,
Mufti
A
,
Maliyar
K
,
Sibbald
C
,
Alavi
A
.
Biologic use in pediatric patients with hidradenitis suppurativa: a systematic review
.
J Cutan Med Surg
.
2021
;
26
(
2
):
176
180
92
Bi
Y
,
Liu
J
,
Wang
J
, et al
.
Model-informed drug development approach supporting approval of adalimumab (HUMIRA) in adolescent patients with hidradenitis suppurativa: a regulatory perspective
.
AAPS J
.
2019
;
21
(
5
):
91
93
Lee
RA
,
Dommasch
E
,
Treat
J
, et al
.
A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa
.
J Am Acad Dermatol
.
2009
;
60
(
4
):
565
573
94
Ring
HC
,
Maul
JT
,
Yao
Y
, et al
.
Drug survival of biologics in patients with hidradenitis suppurativa
.
JAMA Dermatol
.
2022
;
158
(
2
):
184
188
95
Adams
DR
,
Yankura
JA
,
Fogelberg
AC
,
Anderson
BE
.
Treatment of hidradenitis suppurativa with etanercept injection
.
Arch Dermatol
.
2010
;
146
(
5
):
501
504
96
US Food and Drug Administration
.
Humira (adalimumab) [package insert]
.
97
Ruggiero
A
,
Martora
F
,
Picone
V
,
Marano
L
,
Fabbrocini
G
,
Marasca
C
.
Paradoxical hidradenitis suppurativa during biologic therapy, an emerging challenge: a systematic review
.
Biomedicines
.
2022
;
10
(
2
):
455
98
Casseres
RG
,
Prussick
L
,
Zancanaro
P
, et al
.
Secukinumab in the treatment of moderate to severe hidradenitis suppurativa: results of an open-label trial
.
J Am Acad Dermatol
.
2020
;
82
(
6
):
1524
1526
99
Prussick
L
,
Rothstein
B
,
Joshipura
D
, et al
.
Open-label, investigator-initiated, single-site exploratory trial evaluating secukinumab, an anti-interleukin-17A monoclonal antibody, for patients with moderate-to-severe hidradenitis suppurativa
.
Br J Dermatol
.
2019
;
181
(
3
):
609
611
100
Munshi
MA
,
Noe
MH
,
Chiu
YE
,
Streicher
JL
.
Vaccines: considerations for pediatric dermatology patients on immunosuppressive agents
.
Pediatr Dermatol
.
2021
;
38
(
5
):
1040
1046
101
Horissian
M
,
Maczuga
S
,
Barbieri
JS
,
Zaenglein
AL
.
Trends in the prescribing pattern of spironolactone for acne and hidradenitis suppurativa in adolescents
.
J Am Acad Dermatol
.
2022
;
87
(
3
):
684
686
102
Montero-Vilchez
T
,
Valenzuela-Amigo
A
,
Cuenca-Barrales
C
,
Arias-Santiago
S
,
Leyva-García
A
,
Molina-Leyva
A
.
The role of oral contraceptive pills in hidradenitis suppurativa: a cohort study
.
Life (Basel)
.
2021
;
11
(
7
):
697
103
Yazdanyar
S
,
Jemec
GB
.
KITTEN following CAT on the long-term use of rifampicin in hidradenitis suppurativa and effectiveness of oral contraceptives
.
Br J Dermatol
.
2019
;
181
(
1
):
225
226
104
Plovanich
M
,
Weng
QY
,
Mostaghimi
A
.
Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne
.
JAMA Dermatol
.
2015
;
151
(
9
):
941
944
105
Babbush
KM
,
Andriano
TM
,
Cohen
SR
.
Antiandrogen therapy in hidradenitis suppurativa: finasteride for females
.
Clin Exp Dermatol
.
2022
;
47
(
1
):
86
92
106
Moussa
C
,
Wadowski
L
,
Price
H
,
Mirea
L
,
O’Haver
J
.
Metformin as adjunctive therapy for pediatric patients with hidradenitis suppurativa
.
J Drugs Dermatol
.
2020
;
19
(
12
):
1231
1234
107
Boer
J
,
van Gemert
MJ
.
Long-term results of isotretinoin in the treatment of 68 patients with hidradenitis suppurativa
.
J Am Acad Dermatol
.
1999
;
40
(
1
):
73
76
108
Dicken
CH
,
Powell
ST
,
Spear
KL
.
Evaluation of isotretinoin treatment of hidradenitis suppurativa
.
J Am Acad Dermatol
.
1984
;
11
(
3
):
500
502
109
Patel
N
,
McKenzie
SA
,
Harview
CL
, et al
.
Isotretinoin in the treatment of hidradenitis suppurativa: a retrospective study
.
J Dermatolog Treat
.
2021
;
32
(
4
):
473
475
110
McPhie
ML
,
Bridgman
AC
,
Kirchhof
MG
.
Combination therapies for hidradenitis suppurativa: a retrospective chart review of 31 patients
.
J Cutan Med Surg
.
2019
;
23
(
3
):
270
276
111
Armyra
K
,
Kouris
A
,
Markantoni
V
,
Katsambas
A
,
Kontochristopoulos
G
.
Hidradenitis suppurativa treated with tetracycline in combination with colchicine: a prospective series of 20 patients
.
Int J Dermatol
.
2017
;
56
(
3
):
346
350
112
Leszczynska
M
,
Diaz
LZ
,
Peña-Robichaux
V
.
Surgical deroofing in pediatric patients with hidradenitis suppurativa
.
Pediatr Dermatol
.
2022
;
39
(
3
):
502
505
113
Molinelli
E
,
Sapigni
C
,
Simonetti
O
,
Brisigotti
V
,
Giuliodori
K
,
Offidani
A
.
Alexandrite laser as an adjuvant therapy in the management of mild to moderate hidradenitis suppurativa: a controlled prospective clinical study
.
J Am Acad Dermatol
.
2022
;
87
(
3
):
674
675
114
Shih
T
,
Lee
K
,
Seivright
JR
,
De
DR
,
Shi
VY
,
Hsiao
JL
.
Hyperhidrosis treatments in hidradenitis suppurativa: a systematic review
.
Dermatol Ther (Heidelb)
.
2022
;
35
(
1
):
e15210
115
Jørgensen
AR
,
Yao
Y
,
Thomsen
SF
,
Ring
HC
.
Treatment of hidradenitis suppurativa with tetracycline, doxycycline, or lymecycline: a prospective study
.
Int J Dermatol
.
2021
;
60
(
7
):
785
791
116
Bettoli
V
,
Toni
G
,
Odorici
G
,
Forconi
R
,
Corazza
M
.
Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa-acne inversa in patients of paediatric age: a pilot prospective study
.
Br J Dermatol
.
2021
;
185
(
1
):
216
217
117
US Food and Drug Administration
.
Invanz (ertapenem) [package insert]
.
118
Kimball
AB
,
Okun
MM
,
Williams
DA
, et al
.
Two phase 3 trials of adalimumab for hidradenitis suppurativa
.
N Engl J Med
.
2016
;
375
(
5
):
422
434
119
Shih
T
,
Lee
K
,
Grogan
T
,
De
DR
,
Shi
VY
,
Hsiao
JL
.
Infliximab in hidradenitis suppurativa: a systematic review and meta-analysis
.
Dermatol Ther (Heidelb)
.
2022
;
35
(
9
):
e15691
120
Esme
P
,
Botsali
A
,
Akoglu
G
,
Caliskan
E
.
An anti-interleukin-17A monoclonal antibody, ixekizumab, in the treatment of resistant hidradenitis suppurativa: a case series
.
Skin Appendage Disord
.
2022
;
8
(
4
):
342
345
121
Lee
A
,
Fischer
G
.
A case series of 20 women with hidradenitis suppurativa treated with spironolactone
.
Australas J Dermatol
.
2015
;
56
(
3
):
192
196
122
Mota
F
,
Machado
S
,
Selores
M
.
Hidradenitis suppurativa in children treated with finasteride-a case series
.
Pediatr Dermatol
.
2017
;
34
(
5
):
578
583
123
Duarte
B
,
Cunha
N
,
Lencastre
A
,
Cabete
J
.
Systemic steroids in the management of moderate-to-severe hidradenitis suppurativa
.
Actas Dermosifiliogr (Engl Ed)
.
2020
;
111
(
10
):
879
883
124
Riis
PT
,
Boer
J
,
Prens
EP
, et al
.
Intralesional triamcinolone for flares of hidradenitis suppurativa (HS): a case series
.
J Am Acad Dermatol
.
2016
;
75
(
6
):
1151
1155
125
Anderson
MD
,
Zauli
S
,
Bettoli
V
,
Boer
J
,
Jemec
GB
.
Cyclosporine treatment of severe hidradenitis suppurativa--a case series
.
J Dermatolog Treat
.
2016
;
27
(
3
):
247
250