Clinical Characteristics and Management of Pediatric Hidradenitis Suppurativa: A Canadian Single-Centre Multidisciplinary Experience

Background: Hidradenitis suppurativa (HS) is a highly comorbid condition understudied in pediatric populations. Furthermore, the underrepresentation of Canadians in HS research limits our evaluation of care in real-world Canadian settings. Objectives: To describe the demographics, clinical characteristics, psychosocial burden, and management of pediatric HS at a Canadian hospital. Methods: We developed the infrastructure for a Canada-wide HS registry and piloted it at a pediatric HS tertiary care centre. A retrospective review of patients seen was performed using data collection forms (DCFs) developed for the registry. Results: The 39 patients included were 53.8% female and 100.0% nonsmokers. Asians were overrepresented compared to other North American studies. Most had Hurley stage II (60.5%) or III (28.9%) disease. Mean delay to diagnosis was 2.1 ± 2.0 years. Obesity (57.9%), acne (30.7%), folliculitis (23.1%), and trisomy 21 (23.1%) were the most common comorbidities. Patients with trisomy 21 had an age of HS onset 3 years younger ( P = .0087), and 44.0% had concomitant disseminate and recurrent infundibulofolliculitis. Moderate-to-severe quality of life (QOL) impact was seen in 56.8% of patients, and 17.6% had reported bullying. Of patients prescribed biologics (59.0%), most used 1 (56.6%), while 39.1% switched to a second and 4.3% to a third biologic. Most adalimumab-initiated patients clinically improved (81.0%), but only 2 patients achieved complete remission. Follow-up patients (n = 14) had significant improvements in QOL ( P = .038) and pain ( P = .026) scores. Conclusions: Distinct demographics, severe disease, and low remission rates characterized our complex HS cohort. Prospective use of these DCFs will enhance our understanding of HS in Canada.