Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients.

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.

The Follicular Skin Microbiome in Patients With Hidradenitis Suppurativa and Healthy Controls.

Importance: Although the pathogenesis of hidradenitis suppurativa (HS) remains enigmatic, several factors point to potential involvement of the cutaneous microbiome. Insight into the cutaneous microbiome in HS using next-generation sequencing may provide novel data on the microbiological diversity of the skin. Objective: To investigate the follicular skin microbiome in patients with HS and in healthy controls. Design, Setting, and Participants: This case-control study obtained punch biopsy specimens from patients with HS (lesional and nonlesional) and healthy controls between October 1, 2014, and August 1, 2016. Data were analyzed from March to November 2016. Patients with HS were recruited from the Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. Biopsy specimens were analyzed at the Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark. None of the participants received any antibiotics (systemic or topical therapy) within 1 month before the study. In patients with HS, biopsy specimens were obtained from lesional skin (axilla or groin) and nonlesional skin. Only nodules containing at least 1 visible hair follicle were biopsied. Biopsy specimens from healthy controls were obtained from the axilla only. Main Outcomes and Measures: The different microbiomes were investigated using next-generation sequencing targeting 16S and 18S ribosomal RNA. Results: The skin microbiome was characterized in 30 patients with HS (mean [SD] age, 46.9 [14.0] years; 19 [63% female]) and 24 healthy controls (mean [SD] age, 32.2 [12.0] years; 13 [54% female]). The next-generation sequencing data provided a previously unreported (to our knowledge) characterization of the skin microbiome in HS. The study demonstrated that the microbiome in HS differs significantly from that in healthy controls in lesional and nonlesional skin. Overall, the following 5 microbiome types were identified: Corynebacterium species (type I), Acinetobacter and Moraxella species (type II), Staphylococcus epidermidis (type III), Porphyromonas and Peptoniphilus species (type IV), and Propionibacterium acnes (type V). In lesional skin, microbiome types consisted predominantly of type I or type IV. Microbiome type IV was not detected in healthy controls. Several taxa, including Propionibacterium, showed a significantly higher relative abundance in healthy controls vs HS skin, indicating that Propionibacterium may be part of the pathogenesis in HS. Conclusions and Relevance: The study findings suggest a link between a dysbiotic cutaneous microbiome and HS.

The Role of Androgens and Estrogens in Hidradenitis Suppurativa - A Systematic Review.

Hidradenitis suppurativa (HS) is an inflammatory skin disease. Several observations imply that sex hormones may play a role in its pathogenesis. HS is more common in women, and the disease severity appears to vary in intensity according to the menstrual cycle. In addition, parallels have been drawn between HS and acne vulgaris, suggesting that sex hormones may play a role in the condition. The role of androgens and estrogens in HS has therefore been explored in numerous observational and some interventional studies; however, the studies have often reported conflicting results. This systematic review includes 59 unique articles and aims to give an overview of the available research. Articles containing information on natural variation, severity changes during menstruation and pregnancy, as well as articles on serum levels of hormones in patients with HS and the therapeutic options of hormonal manipulation therapy have all been included and are presented in this systematic review. Our results show that patients with HS do not seem to have increased levels of sex hormones and that their hormone levels lie within the normal range. While decreasing levels of progesterone and estrogen seem to coincide with disease flares in premenopausal women, the association is speculative and requires experimental confirmation. Antiandrogen treatment could be a valuable approach in treating HS, however randomized control trials are lacking.