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Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options

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Abstract

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin condition that manifests as painful, deep-seated, inflamed nodules and abscesses in the axillary, groin, perianal, perineal, and inframammary regions. The associated pain, malodour, and disfigurement contribute to its profound negative impact on psychosocial spheres and overall quality of life in affected individuals. Although the symptoms of HS classically begin in the second or third decade of life, HS affects children and adolescents as well. Despite this, there are limited pediatric data on treatment, which are largely based on expert opinion, extrapolation of efficacy data in adults with HS, and safety information from medication use in other pediatric diseases. On this basis, there exist several pharmacological modalities in the treatment of children and adolescents with HS including topical therapies, systemic therapies, and biologics. The goals of this review article are to: (1) review the efficacy of different pharmacological treatment modalities in children and adolescents with HS, and (2) review the safety and monitoring considerations of the different treatment options in children and adolescents with HS.

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References

  1. Jemec GBE. Hidradenitis suppurativa. N Engl J Med. 2012;366:158–64. https://doi.org/10.1056/NEJMcp1014163.

    Article  CAS  PubMed  Google Scholar 

  2. Ingram J. Hidradenitis suppurativa: Pathogenesis, clinical features, and diagnosis - UpToDate. UpToDate 2022. https://www-uptodate-com.myaccess.library.utoronto.ca/contents/hidradenitis-suppurativa-pathogenesis-clinical-features-and-diagnosis?search=hidradenitis&source=search_result&selectedTitle=2~82&usage_type=default&display_rank=2. Accessed 10 March 2023.

  3. Zouboulis Cc, Desai N, Emtestam L, Hunger Re, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29:619–44. https://doi.org/10.1111/jdv.12966.

    Article  CAS  PubMed  Google Scholar 

  4. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, 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;81:91–101. https://doi.org/10.1016/j.jaad.2019.02.068.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mikkelsen PR, Jemec GBE. Hidradenitis suppurativa in children and sdolescents: a review of treatment options. Pediatr Drugs. 2014;16:483–9. https://doi.org/10.1007/s40272-014-0091-3.

    Article  Google Scholar 

  6. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60:539–61. https://doi.org/10.1016/j.jaad.2008.11.911.

    Article  PubMed  Google Scholar 

  7. Napolitano M, Megna M, Timoshchuk EA, Patruno C, Balato N, Fabbrocini G, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105–15. https://doi.org/10.2147/CCID.S111019.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wieczorek M, Walecka I. Hidradenitis suppurative—known and unknown disease. Reumatologia. 2018;56:337–9. https://doi.org/10.5114/reum.2018.80709.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cartron A, Driscoll MS. Comorbidities of hidradenitis suppurativa: a review of the literature. Int J Womens Dermatol. 2019;5:330–4. https://doi.org/10.1016/j.ijwd.2019.06.026.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chicarilli ZN. Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. Ann Plast Surg. 1987;18:230–7. https://doi.org/10.1097/00000637-198703000-00009.

    Article  CAS  PubMed  Google Scholar 

  11. 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;79:514–9. https://doi.org/10.1016/j.jaad.2018.02.067.

    Article  PubMed  Google Scholar 

  12. Seivright J, Collier E, Grogan T, Hogeling M, Shi VY, Hsiao JL. Physical and psychosocial comorbidities of pediatric hidradenitis suppurativa: a retrospective analysis. Pediatr Dermatol. 2021;38:1132–6. https://doi.org/10.1111/pde.14765.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429–34. https://doi.org/10.1001/jamadermatol.2015.6264.

    Article  PubMed  Google Scholar 

  14. Choi E, Ooi XT, Chandran NS. Hidradenitis suppurativa in pediatric patients. J Am Acad Dermatol. 2022;86:140–7. https://doi.org/10.1016/j.jaad.2020.08.045.

    Article  PubMed  Google Scholar 

  15. Liy-Wong C, Kim M, Kirkorian AY, Eichenfield LF, Diaz LZ, Horev A, et al. Hidradenitis suppurativa in the pediatric population. JAMA Dermatol. 2021;157:1–7. https://doi.org/10.1001/jamadermatol.2020.5435.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Liy-Wong C, Pope E, Lara-Corrales I. Hidradenitis suppurativa in the pediatric population. J Am Acad Dermatol. 2015;73:S36-41. https://doi.org/10.1016/j.jaad.2015.07.051.

    Article  PubMed  Google Scholar 

  17. Riis PT, Saunte DM, Sigsgaard V, Villani AP, Guillem P, Pascual JC, et al. Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients. Arch Dermatol Res. 2020;312:715–24. https://doi.org/10.1007/s00403-020-02053-6.

    Article  CAS  PubMed  Google Scholar 

  18. Dessinioti C, Tzanetakou V, Zisimou C, Kontochristopoulos G, Antoniou C. A retrospective study of the characteristics of patients with early-onset compared to adult-onset hidradenitis suppurativa. Int J Dermatol. 2018;57:687–91. https://doi.org/10.1111/ijd.13985.

    Article  PubMed  Google Scholar 

  19. 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;72:485–8. https://doi.org/10.1016/j.jaad.2014.11.017.

    Article  PubMed  Google Scholar 

  20. Bettoli V, Ricci M, Zauli S, Virgili A. Hidradenitis suppurativa–acne inversa: a relevant dermatosis in paediatric patients. Br J Dermatol. 2015;173:1328–30. https://doi.org/10.1111/bjd.13951.

    Article  CAS  PubMed  Google Scholar 

  21. Offidani A, Molinelli E, Sechi A, Brisigotti V, Campanati A, Raone B, et al. Hidradenitis suppurativa in a prepubertal case series: a call for specific guidelines. J Eur Acad Dermatol Venereol. 2019;33:28–31. https://doi.org/10.1111/jdv.15827.

    Article  PubMed  Google Scholar 

  22. Kittler NW, Williams JC, Kudlinski MV, Lester J, Hills N, Abuabara K, et al. Evaluation of hidradenitis suppurativa diagnostic criteria in pediatric patients. JAMA Dermatol. 2022;158:1404–8. https://doi.org/10.1001/jamadermatol.2022.4564.

    Article  PubMed  Google Scholar 

  23. Masson R, Parvathala N, Ma E, Shih T, Atluri S, Sayed CJ, et al. Efficacy of procedural treatments for pediatric hidradenitis suppurativa: a systematic review. Pediatr Dermatol. 2023. https://doi.org/10.1111/pde.15331.

    Article  PubMed  Google Scholar 

  24. Collier E, Shi VY, Hsiao JL. Management of adolescents with hidradenitis suppurativa. J Dermatol Treat. 2021;32:1035–8. https://doi.org/10.1080/09546634.2020.1716933.

    Article  Google Scholar 

  25. De Vere Hunt IJ, Howard E, McPherson T. The impact of chronic skin disease in adolescence and the need for specialist adolescent services. Clin Exp Dermatol. 2020;45:5–9. https://doi.org/10.1111/ced.14021.

    Article  PubMed  Google Scholar 

  26. Garcovich S, Fania L, Caposiena D, Giovanardi G, Chiricozzi A, De Simone C, et al. Pediatric hidradenitis suppurativa: a cross-sectional study on clinical features and treatment approaches. J Cutan Med Surg. 2022;26:127–34. https://doi.org/10.1177/12034754211039993.

    Article  CAS  PubMed  Google Scholar 

  27. 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;82:502–4. https://doi.org/10.1016/j.jaad.2019.08.034.

    Article  PubMed  Google Scholar 

  28. Sivanand A, Gulliver WP, Josan CK, Alhusayen R, Fleming PJ. Weight loss and dietary interventions for hidradenitis suppurativa: a systematic review. J Cutan Med Surg. 2020;24:64–72. https://doi.org/10.1177/1203475419874412.

    Article  PubMed  Google Scholar 

  29. Reichert B, Fernandez Faith E, Harfmann K. Weight counseling in pediatric hidradenitis suppurativa patients. Pediatr Dermatol. 2020;37:480–3. https://doi.org/10.1111/pde.14131.

    Article  PubMed  Google Scholar 

  30. Wright S, Strunk A, Garg A. New-onset depression among children, adolescents, and adults with hidradenitis suppurativa. J Am Acad Dermatol. 2020;83:1360–6. https://doi.org/10.1016/j.jaad.2020.05.090.

    Article  PubMed  Google Scholar 

  31. Seivright J, Collier E, Grogan T, Shih T, Hogeling M, Shi VY, et al. Pediatric hidradenitis suppurativa: epidemiology, disease presentation, and treatments. J Dermatol Treat. 2022;33:2391–3. https://doi.org/10.1080/09546634.2021.1937484.

    Article  Google Scholar 

  32. Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol. 1983;22:325–8. https://doi.org/10.1111/j.1365-4362.1983.tb02150.x.

    Article  CAS  PubMed  Google Scholar 

  33. Eichenfield LF, Stein Gold L, Kircik LH, Werschler WP, Beer K, Draelos ZD, et al. Triple-combination clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel for moderate-to-severe acne in children and adolescents: randomized phase 2 study. Pediatr Dermatol. 2023;40:452–9. https://doi.org/10.1111/pde.15283.

    Article  PubMed  Google Scholar 

  34. Eichenfield LF, Krakowski AC. Moderate to severe acne in adolescents with skin of color: benefits of a fixed combination clindamycin phosphate 1.2% and benzoyl peroxide 2.5% aqueous gel. J Drugs Dermatol. 2012;11:818–24.

    CAS  PubMed  Google Scholar 

  35. Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131:S163–86. https://doi.org/10.1542/peds.2013-0490B.

    Article  PubMed  Google Scholar 

  36. Boer J, Jemec GBE. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol. 2010;35:36–40. https://doi.org/10.1111/j.1365-2230.2009.03377.x.

    Article  CAS  PubMed  Google Scholar 

  37. Pascual JC, Encabo B, de Apodaca RFR, Romero D, Selva J, Jemec GB. Topical 15% resorcinol for hidradenitis suppurativa: an uncontrolled prospective trial with clinical and ultrasonographic follow-up. J Am Acad Dermatol. 2017;77:1175–8. https://doi.org/10.1016/j.jaad.2017.07.008.

    Article  PubMed  Google Scholar 

  38. Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I. Medical and surgical management of hidradenitis suppurativa: a review of international treatment guidelines and implementation in general dermatology practice. Dermatology. 2020;236:393–412. https://doi.org/10.1159/000507323.

    Article  CAS  PubMed  Google Scholar 

  39. Leiphart P, Ma H, Naik HB, Kirby JS. The effect of antimicrobial washes on antibacterial resistance in hidradenitis suppurativa lesions. J Am Acad Dermatol. 2019;80:821–2. https://doi.org/10.1016/j.jaad.2018.10.063.

    Article  PubMed  Google Scholar 

  40. Frew JW, Hawkes JE, Krueger JG. Topical, systemic and biologic therapies in hidradenitis suppurativa: pathogenic insights by examining therapeutic mechanisms. Ther Adv Chronic Dis. 2019;10:2040622319830646. https://doi.org/10.1177/2040622319830646.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Rundle CW, Price KN, Hogeling M, Hsiao JL, Shi VY. Recent advances in hidradenitis suppurativa in pediatrics. Dermatol Online J. 2020. https://doi.org/10.5070/D32612051346.

    Article  PubMed  Google Scholar 

  42. Brocard A, Knol A-C, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. Dermatology. 2007;214:325–7. https://doi.org/10.1159/000100883.

    Article  CAS  PubMed  Google Scholar 

  43. Duncan A, Yacoubian C, Watson N, Morrison I. The risk of copper deficiency in patients prescribed zinc supplements. J Clin Pathol. 2015;68:723–5. https://doi.org/10.1136/jclinpath-2014-202837.

    Article  CAS  PubMed  Google Scholar 

  44. Bettoli V, Zauli S, Virgili A. Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa-acne inversa: can some factors influence the response to the treatment? G Ital Dermatol E Venereol Organo Uff Soc Ital Dermatol E Sifilogr. 2016;151:216–8.

    Google Scholar 

  45. 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;185:216–7. https://doi.org/10.1111/bjd.19867.

    Article  CAS  PubMed  Google Scholar 

  46. Bettoli V, Zauli S, Borghi A, Toni G, Minghetti S, Ricci M, et al. Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa-acne inversa: a prospective study on 23 patients. J Eur Acad Dermatol Venereol. 2014;28:125–6. https://doi.org/10.1111/jdv.12127.

    Article  CAS  PubMed  Google Scholar 

  47. Seddon JA, Johnson S, Palmer M, van der Zalm MM, Lopez-Varela E, Hughes J, et al. Multidrug-resistant tuberculosis in children and adolescents: current strategies for prevention and treatment. Expert Rev Respir Med. 2021;15:221–37. https://doi.org/10.1080/17476348.2021.1828069.

    Article  CAS  PubMed  Google Scholar 

  48. Xi Y, Zhang W, Qiao R-J, Tang J. Risk factors for multidrug-resistant tuberculosis: a worldwide systematic review and meta-analysis. PLoS ONE. 2022;17: e0270003. https://doi.org/10.1371/journal.pone.0270003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Caposiena Caro RD, Cannizzaro MV, Botti E, Di Raimondo C, Di Matteo E, Gaziano R, et al. Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasound observations. J Am Acad Dermatol. 2019;80:1314–21. https://doi.org/10.1016/j.jaad.2018.11.035.

    Article  CAS  PubMed  Google Scholar 

  50. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39:971–4. https://doi.org/10.1016/s0190-9622(98)70272-5.

    Article  CAS  PubMed  Google Scholar 

  51. Patel K, Leszczynska M, Peña-Robichaux V, Diaz LZ. Caring for pediatric hidradenitis suppurativa patients in the emergency department. Pediatr Emerg Care. 2021;37:312. https://doi.org/10.1097/PEC.0000000000002448.

    Article  PubMed  Google Scholar 

  52. Lambert RA, Stein SL. Pediatric hidradenitis suppurativa: describing care patterns in the emergency department. Pediatr Dermatol. 2023;40:434–9. https://doi.org/10.1111/pde.15231.

    Article  PubMed  Google Scholar 

  53. Todd SR, Dahlgren FS, Traeger MS, Beltrán-Aguilar ED, Marianos DW, Hamilton C, et al. No visible dental staining in children treated with doxycycline for suspected rocky mountain spotted fever. J Pediatr. 2015;166:1246–51. https://doi.org/10.1016/j.jpeds.2015.02.015.

    Article  CAS  PubMed  Google Scholar 

  54. Volovitz B, Shkap R, Amir J, Calderon S, Varsano I, Nussinovitch M. Absence of tooth staining with doxycycline treatment in young children. Clin Pediatr (Phila). 2007;46:121–6. https://doi.org/10.1177/0009922806290026.

    Article  PubMed  Google Scholar 

  55. Yazdanyar S, Boer J, Ingvarsson G, Szepietowski JC, Jemec GBE. Dapsone therapy for hidradenitis suppurativa: a series of 24 patients. Dermatol Basel Switz. 2011;222:342–6. https://doi.org/10.1159/000329023.

    Article  CAS  Google Scholar 

  56. Steyn M, Ayis S, O’Connor J, Lakhan MK, Ferguson F, Shah A, et al. Dapsone therapy for hidradenitis suppurativa: a retrospective review of characteristics and treatment outcomes in a cohort of 122 patients in a tertiary dermatology setting. Br J Dermatol. 2022. https://doi.org/10.1093/bjd/ljac120.

    Article  Google Scholar 

  57. Stavola JJ, Noel GJ. Efficacy and safety of dapsone prophylaxis against Pneumocystis carinii pneumonia in human immunodeficiency virus-infected children. Pediatr Infect Dis J. 1993;12:644–7. https://doi.org/10.1097/00006454-199308000-00004.

    Article  CAS  PubMed  Google Scholar 

  58. Meeker ND, Goldsby R, Terrill KR, Delaney KS, Slayton WB. Dapsone therapy for children with immune thrombocytopenic purpura. J Pediatr Hematol Oncol. 2003;25:173.

    Article  PubMed  Google Scholar 

  59. Kliegman R, Stanton B, St. Geme J, Schor N. Nelson textbook of pediatrics Elsevier eBook on VitalSource. 20th ed. Berlin: Elsevier; 2015.

    Google Scholar 

  60. Join-Lambert O, Coignard-Biehler H, Jais J-P, Delage M, Guet-Revillet H, Poirée S, et al. Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients. J Antimicrob Chemother. 2016;71:513–20. https://doi.org/10.1093/jac/dkv361.

    Article  CAS  PubMed  Google Scholar 

  61. Nicholson C, Ford H, Williams M. The use of intravenous ertapenem in the management of severe hidradenitis suppurativa. J Am Acad Dermatol. 2016;74:AB9. https://doi.org/10.1016/j.jaad.2016.02.036.

    Article  Google Scholar 

  62. Arguedas A, Cespedes J, Botet FA, Blumer J, Yogev R, Gesser R, et al. Safety and tolerability of ertapenem versus ceftriaxone in a double-blind study performed in children with complicated urinary tract infection, community-acquired pneumonia or skin and soft-tissue infection. Int J Antimicrob Agents. 2009;33:163–7. https://doi.org/10.1016/j.ijantimicag.2008.08.005.

    Article  CAS  PubMed  Google Scholar 

  63. Karaaslan A, Kadayifci EK, Atici S, Akkoc G, Yakut N, Öcal Demir S, et al. The clinical efficacy and safety of ertapenem for the treatment of complicated urinary tract infections caused by esbl-producing bacteria in children. Int J Nephrol. 2015. https://doi.org/10.1155/2015/595840.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Zhao R, Long X, Wang J, Zhu J, Liu C, Shang T, et al. Effectiveness of ertapenem for treatment of infections in children: an evidence mapping and meta-analysis. Front Pediatr 2022;10:982179.

  65. Abdel-Rahman SM, Kearns GL, Topelberg S, Jacobs RF, Mistry GC, Majumdar A, et al. Pharmacokinetics and tolerability of single-dose intravenous ertapenem in infants, children and adolescents. Pediatr Infect Dis J. 2010;29:1072–6. https://doi.org/10.1097/INF.0b013e3181e82608.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, et al. Consensus on the treatment of hidradenitis suppurative—Brazilian Society of Dermatology. An Bras Dermatol. 2019;94:7–19. https://doi.org/10.1590/abd1806-4841.20198607.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Fajgenbaum K, Crouse L, Dong L, Zeng D, Sayed C. Intralesional triamcinolone may not be beneficial for treating acute hidradenitis suppurativa lesions: a double-blind, randomized, placebo-controlled trial. Dermatol Surg. 2020;46:685. https://doi.org/10.1097/DSS.0000000000002112.

    Article  CAS  PubMed  Google Scholar 

  68. Saunte DML, Jemec GBE. Intralesional triamcinolone for hidradenitis suppurativa—how much is needed? Dermatol Surg. 2021;47:1013. https://doi.org/10.1097/DSS.0000000000002753.

    Article  CAS  PubMed  Google Scholar 

  69. Álvarez P, García-Martínez FJ, Poveda I, Pascual JC. Intralesional triamcinolone for fistulous tracts in hidradenitis suppurativa: an uncontrolled prospective trial with clinical and ultrasonographic follow-up. Dermatology. 2020;236:46–51. https://doi.org/10.1159/000499934.

    Article  CAS  PubMed  Google Scholar 

  70. Anderson MD, Zauli S, Bettoli V, Boer J, Jemec GBE. Cyclosporine treatment of severe Hidradenitis suppurative—a case series. J Dermatol Treat. 2016;27:247–50. https://doi.org/10.3109/09546634.2015.1088128.

    Article  CAS  Google Scholar 

  71. Abu Rached N, Gambichler T, Dietrich JW, Ocker L, Seifert C, Stockfleth E, et al. The role of hormones in hidradenitis suppurativa: a systematic review. Int J Mol Sci. 2022;23:15250. https://doi.org/10.3390/ijms232315250.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Kraft JN, Searles GE. Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy. J Cutan Med Surg. 2007;11:125–31. https://doi.org/10.2310/7750.2007.00019.

    Article  CAS  PubMed  Google Scholar 

  73. McPhie ML, Bridgman AC, Kirchhof MG. Combination therapies for hidradenitis suppurativa: a retrospective chart review of 31 patients. J Cutan Med Surg. 2019;23:270–6. https://doi.org/10.1177/1203475418823529.

    Article  CAS  PubMed  Google Scholar 

  74. 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;87:684–6. https://doi.org/10.1016/j.jaad.2021.12.005.

    Article  CAS  PubMed  Google Scholar 

  75. Clark AK, Quinonez RL, Saric S, Sivamani RK. Hormonal therapies for hidradenitis suppurativa: Review. Dermatol Online J. 2017;23:13030/qt6383k0n4.

    PubMed  Google Scholar 

  76. Khandalavala BN, Do MV. Finasteride in hidradenitis suppurativa. J Clin Aesthetic Dermatol. 2016;9:44–50.

    Google Scholar 

  77. Randhawa HK, Hamilton J, Pope E. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. JAMA Dermatol. 2013;149:732–5. https://doi.org/10.1001/jamadermatol.2013.2874.

    Article  PubMed  Google Scholar 

  78. Mota F, Machado S, Selores M. Hidradenitis suppurativa in children treated with finasteride—a case series. Pediatr Dermatol. 2017;34:578–83. https://doi.org/10.1111/pde.13216.

    Article  PubMed  Google Scholar 

  79. Irwig MS. Persistent sexual side effects of finasteride: could they be permanent? J Sex Med. 2012;9:2927–32. https://doi.org/10.1111/j.1743-6109.2012.02846.x.

    Article  PubMed  Google Scholar 

  80. Oliveira-Soares R, André MC, Peres-Correia M. Adverse effects with finasteride 5 mg/day for patterned hair loss in premenopausal women. Int J Trichology. 2018;10:48–50. https://doi.org/10.4103/ijt.ijt_73_15.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Verdolini R, Clayton N, Smith A, Alwash N, Mannello B. Metformin for the treatment of hidradenitis suppurativa: a little help along the way. J Eur Acad Dermatol Venereol. 2013;27:1101–8. https://doi.org/10.1111/j.1468-3083.2012.04668.x.

    Article  CAS  PubMed  Google Scholar 

  82. Jennings L, Hambly R, Hughes R, Moriarty B, Kirby B. Metformin use in hidradenitis suppurativa. J Dermatol Treat. 2020;31:261–3. https://doi.org/10.1080/09546634.2019.1592100.

    Article  CAS  Google Scholar 

  83. Soliman A, De Sanctis V, Alaaraj N, Hamed N. The clinical application of metformin in children and adolescents: a short update. Acta Bio Medica Atenei Parm. 2020;91: e2020086. https://doi.org/10.23750/abm.v91i3.10127.

    Article  CAS  Google Scholar 

  84. Marques P, Limbert C, Oliveira L, Santos MI, Lopes L. Metformin effectiveness and safety in the management of overweight/obese nondiabetic children and adolescents: metabolic benefits of the continuous exposure to metformin at 12 and 24 months. Int J Adolesc Med Health. 2017. https://doi.org/10.1515/ijamh-2015-0110.

    Article  Google Scholar 

  85. Srinivasan S, Ambler GR, Baur LA, Garnett SP, Tepsa M, Yap F, et al. Randomized, Controlled trial of metformin for obesity and insulin resistance in children and adolescents: Improvement in body composition and fasting insulin. J Clin Endocrinol Metab. 2006;91:2074–80. https://doi.org/10.1210/jc.2006-0241.

    Article  CAS  PubMed  Google Scholar 

  86. Soria A, Canoui-Poitrine F, Wolkenstein P, Poli F, Gabison G, Pouget F, et al. Absence of efficacy of oral isotretinoin in hidradenitis suppurativa: a retrospective study based on patients’ outcome assessment. Dermatol Basel Switz. 2009;218:134–5. https://doi.org/10.1159/000182261.

    Article  CAS  Google Scholar 

  87. Norris JF, Cunliffe WJ. Failure of treatment of familial widespread hidradenitis suppurativa with isotretinoin. Clin Exp Dermatol. 1986;11:579–83. https://doi.org/10.1111/j.1365-2230.1986.tb00512.x.

    Article  CAS  PubMed  Google Scholar 

  88. Huang CM, Kirchhof MG. A new perspective on isotretinoin treatment of hidradenitis suppurativa: a retrospective chart review of patient outcomes. Dermatology. 2017;233:120–5. https://doi.org/10.1159/000477207.

    Article  CAS  PubMed  Google Scholar 

  89. Stojkovic-Filipovic JM, Gajic-Veljic MD, Nikolic M. Prepubertal onset of hidradenitis suppurativa in a girl: a case report and literature review. Indian J Dermatol Venereol Leprol. 2015;81:294. https://doi.org/10.4103/0378-6323.152741.

    Article  PubMed  Google Scholar 

  90. Lopes S, Gomes N, Trindade E, Azevedo F, Magina S. Hidradenitis suppurativa in a prepubertal girl. Acta Dermatovenerol Alp Pannonica Adriat. 2019. https://doi.org/10.15570/actaapa.2019.34.

    Article  PubMed  Google Scholar 

  91. Boer J, Nazary M. Long-term results of acitretin therapy for hidradenitis suppurative. Is acne inversa also a misnomer? Br J Dermatol. 2011;164:170–5. https://doi.org/10.1111/j.1365-2133.2010.10071.x.

    Article  CAS  PubMed  Google Scholar 

  92. Matusiak L, Bieniek A, Szepietowski JC. Acitretin treatment for hidradenitis suppurativa: a prospective series of 17 patients. Br J Dermatol. 2014;171:170–4. https://doi.org/10.1111/bjd.12884.

    Article  CAS  PubMed  Google Scholar 

  93. López-Llunell C, Riera-Martí N, Gamissans M, Romaní J. Dapsone in hidradenitis suppurativa: a case series of 56 patients. Dermatol Ther. 2021;34: e15161. https://doi.org/10.1111/dth.15161.

    Article  CAS  PubMed  Google Scholar 

  94. Meyer E, de Bersaques J, Lambert WE, de Leenheer AP, Kint AH. Skin, adipose tissue and plasma levels of acitretin with rare occurrence of esterified acitretin during long-term treatment. Acta Derm Venereol. 1993;73:113–5. https://doi.org/10.2340/0001555573113115.

    Article  CAS  PubMed  Google Scholar 

  95. Grønhøj Larsen F, Steinkjer B, Jakobsen P, Hjorter A, Brockhoff PB, Nielsen-Kudsk F. Acitretin is converted to etretinate only during concomitant alcohol intake. Br J Dermatol. 2000;143:1164–9. https://doi.org/10.1046/j.1365-2133.2000.03883.x.

    Article  PubMed  Google Scholar 

  96. Allergan Inc. Soriatane Product Monograph 2018.

  97. Martin-Ezquerra G, Masferrer E, Masferrer-Niubò M, Ferran M, Sánchez-Regaña M, Collgros H, et al. Use of biological treatments in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2015;29:56–60. https://doi.org/10.1111/jdv.12438.

    Article  CAS  PubMed  Google Scholar 

  98. McLenon J, Rogers MAM. The fear of needles: a systematic review and meta-analysis. J Adv Nurs. 2019;75:30–42. https://doi.org/10.1111/jan.13818.

    Article  PubMed  Google Scholar 

  99. Doyle R, Donaldson A, Philips L, Nelson L, Clark JE, Wen SCH. The impact of a multidisciplinary care package for vaccination in needle phobic children: An observational study. J Paediatr Child Health. 2022;58:1174–80. https://doi.org/10.1111/jpc.15928.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422–34. https://doi.org/10.1056/NEJMoa1504370.

    Article  CAS  PubMed  Google Scholar 

  101. Jemec GBE, Okun MM, Forman SB, Gulliver WPF, Prens EP, Mrowietz U, et al. Adalimumab medium-term dosing strategy in moderate-to-severe hidradenitis suppurativa: integrated results from the phase III randomized placebo-controlled PIONEER trials. Br J Dermatol. 2019;181:967–75. https://doi.org/10.1111/bjd.17919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. AbbVie Corporation. Humira Product Monograph 2022.

  103. Nguyen Q-BD, Starling CT, Hebert AA. The use of TNFα inhibitors in treating pediatric skin disorders. Pediatr Drugs. 2020;22:311–9. https://doi.org/10.1007/s40272-020-00394-3.

    Article  Google Scholar 

  104. Fougerousse A-C, Reguiai Z, Roussel A, Bécherel P-A. Hidradenitis suppurativa management using tumor necrosis factor inhibitors in patients younger than 18 years: a series of 12 cases. J Am Acad Dermatol. 2020;83:199–201. https://doi.org/10.1016/j.jaad.2020.02.071.

    Article  PubMed  Google Scholar 

  105. 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. 2022;26:176–80. https://doi.org/10.1177/12034754211049711.

    Article  CAS  PubMed  Google Scholar 

  106. Grant A, Gonzalez T, Montgomery MO, Cardenas V, Kerdel FA. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial. J Am Acad Dermatol. 2010;62:205–17. https://doi.org/10.1016/j.jaad.2009.06.050.

    Article  CAS  PubMed  Google Scholar 

  107. Cecchin V, Zannin ME, Ferrari D, Pontikaki I, Miserocchi E, Paroli MP, et al. Longterm safety and efficacy of adalimumab and infliximab for uveitis associated with juvenile idiopathic arthritis. J Rheumatol. 2018;45:1167–72. https://doi.org/10.3899/jrheum.171006.

    Article  CAS  PubMed  Google Scholar 

  108. Kimball AB, Jemec GBE, Alavi A, Reguiai Z, Gottlieb AB, Bechara FG, et al. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): Week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials. The Lancet. 2023;401:747–61. https://doi.org/10.1016/S0140-6736(23)00022-3.

    Article  CAS  Google Scholar 

  109. Glatt S, Jemec GBE, Forman S, Sayed C, Schmieder G, Weisman J, et al. Efficacy and safety of bimekizumab in moderate to severe hidradenitis suppurativa: a phase 2, double-blind, placebo-controlled randomized clinical trial. JAMA Dermatol. 2021;157:1279–88. https://doi.org/10.1001/jamadermatol.2021.2905.

    Article  PubMed  Google Scholar 

  110. Martora F, Megna M, Battista T, Potestio L, Annunziata MC, Marasca C, et al. Adalimumab, ustekinumab, and secukinumab in the management of hidradenitis suppurativa: a review of the real-life experience. Clin Cosmet Investig Dermatol. 2023;16:135–48. https://doi.org/10.2147/CCID.S391356.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Kashetsky N, Mufti A, Alabdulrazzaq S, Lytvyn Y, Sachdeva M, Rahat A, et al. Treatment outcomes of IL-17 inhibitors in hidradenitis suppurativa: a systematic review. J Cutan Med Surg. 2022;26:79–86. https://doi.org/10.1177/12034754211035667.

    Article  CAS  PubMed  Google Scholar 

  112. Lim SYD, Oon HH. Systematic review of immunomodulatory therapies for hidradenitis suppurativa. Biol Targets Ther. 2019;13:53–78. https://doi.org/10.2147/BTT.S199862.

    Article  CAS  Google Scholar 

  113. Markota Čagalj A, Marinović B, Bukvić MZ. New and emerging targeted therapies for hidradenitis suppurativa. Int J Mol Sci. 2022;23:3753. https://doi.org/10.3390/ijms23073753.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Fieldhouse KA, Ukaibe S, Crowley EL, Khanna R, O’Toole A, Gooderham MJ. Inflammatory bowel disease in patients with psoriasis treated with interleukin-17 inhibitors. Drugs Context. 2020;9:2020-2–2021. https://doi.org/10.7573/dic.2020-2-1.

    Article  Google Scholar 

  115. Romaní J, Vilarrasa E, Martorell A, Fuertes I, Ciudad C, Molina-Leyva A. Ustekinumab with intravenous infusion: results in hidradenitis suppurativa. Dermatol Basel Switz. 2020;236:21–4. https://doi.org/10.1159/000501075.

    Article  CAS  Google Scholar 

  116. Blok JL, Li K, Brodmerkel C, Horvátovich P, Jonkman MF, Horváth B. Ustekinumab in hidradenitis suppurativa: clinical results and a search for potential biomarkers in serum. Br J Dermatol. 2016;174:839–46. https://doi.org/10.1111/bjd.14338.

    Article  CAS  PubMed  Google Scholar 

  117. Provini LE, Stellar JJ, Stetzer MN, Nguyen PD, Jen M. Combination hyperbaric oxygen therapy and ustekinumab for severe hidradenitis suppurativa. Pediatr Dermatol. 2019;36:381–3. https://doi.org/10.1111/pde.13775.

    Article  PubMed  Google Scholar 

  118. Monsalvez V. Hidradenitis suppurativa and ulcerative colitis, difficult treatment to control both pathologies at the same time. Exp Dermatol 2019;28(Supplement 2):21.

  119. Dudink K, Bouwman K, Chen Y, DePrimo SE, Munoz-Elias EJ, Aarts P, et al. Guselkumab for hidradenitis suppurativa: a phase II, open-label, mode-of-action study. Br J Dermatol. 2023. https://doi.org/10.1093/bjd/ljad010.

    Article  PubMed  Google Scholar 

  120. Jørgensen AR, Holm JG, Thomsen SF. Guselkumab for hidradenitis suppurativa in a patient with concomitant Crohn’s disease: report and systematic literature review of effectiveness and safety. Clin Case Rep. 2020;8:2874–7. https://doi.org/10.1002/ccr3.3090.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Kimball AB, Prens EP, Passeron T, Maverakis E, Turchin I, Beeck S, et al. Efficacy and safety of risankizumab for the treatment of hidradenitis suppurativa: A phase 2, randomized, placebo-controlled trial. Dermatol Ther. 2023;13:1099–111. https://doi.org/10.1007/s13555-023-00913-3.

    Article  Google Scholar 

  122. Roberts EE, Nowsheen S, Davis DMR, Hand JL, Tollefson MM, Wetter DA. Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol. 2021;38:72–6. https://doi.org/10.1111/pde.14391.

    Article  PubMed  Google Scholar 

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  1. Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Nicholas Chiang

  2. Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Cathryn Sibbald, Rebecca Levy & Irene Lara-Corrales

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N.C. previously worked for Eli Lilly as Medical Information Associate for dermatology and rheumatology and has no other conflicts to declare. C.S. has received honoraria from AbbVie, LEO, Pfizer, Miravo, Novartis, UCB, Sanofi/Regeneron, none of which are directly related to this manuscript. R.L. has received honoraria from Sanofi, AbbVie and L’Oreal and has been a consultant for Sanofi, L’Oreal, Alexion and Celltrion, none of which are directly related to this manuscript. I.L.C. has been an Investigator/or received research support from AbbVie, Eli Lilly, Arcutis, SkIN Canada, La Roche Posse, Sanofi Genzyme, Regeneron; has been a Consultant/Advisor for Sanofi Genzyme, Abeona, Avicanna, Novartis, Eli Lilly; has participated in Speaker bureau for Sanofi Genzyme, AbbVie, Eli Lilly; none of these are directly related to this manuscript.

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NC conducted the search and synthesized the results. NC, CS, RL, and ILC wrote and edited the manuscript. All authors read and approved the final manuscript.

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Chiang, N., Sibbald, C., Levy, R. et al. Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options. Pediatr Drugs 25, 659–676 (2023). https://doi.org/10.1007/s40272-023-00595-6

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