Pediatric Hidradenitis Suppurativa Management
Diagnosis and Screening
- The American Academy of Dermatology recommends screening every pediatric Hidradenitis Suppurativa patient for metabolic syndrome, hormonal imbalances, and psychological comorbidities at diagnosis, as 48% of patients already have scarring at initial dermatologic assessment 1
- Acne vulgaris co-occurs in 29% of pediatric Hidradenitis Suppurativa patients, and isotretinoin should only be used when moderate-to-severe acne is present, not for Hidradenitis Suppurativa alone 1
Medical Management
- The American Academy of Dermatology suggests starting with topical clindamycin 1% twice daily for 12 weeks, combined with antiseptic washes to reduce bacterial resistance, for mild disease (Hurley Stage I) 2, 3
- For moderate disease (Hurley Stage II), first-line systemic therapy is oral doxycycline 100 mg once or twice daily for patients ≥8 years old, with treatment duration up to 4 months (12-16 weeks) 1, 2, 3
- Adalimumab is the first-line biologic with FDA approval for ages ≥12 years (strong recommendation) and suggested for ages 2-11 years, for severe/refractory disease (Hurley Stage III or failed antibiotics) 1, 2, 3
Hormonal Therapy
- Anti-androgens are appropriate for adolescent females and select male patients, with spironolactone suggested for adolescent females requiring anti-androgens 1, 2
- Combined oral contraceptives are suggested for adolescent females 1, 2
Surgical Considerations
- Surgery is often necessary for lasting cure in advanced disease, but timing and technique matter, with deroofing for recurrent nodules and tunnels in localized disease, and radical excision for extensive disease with sinus tracts and scarring 1, 2