Original article
Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement

https://doi.org/10.1016/j.jaad.2014.11.017Get rights and content

Background

The reported mean age of onset of hidradenitis suppurativa (HS) is between 20 and 24 years. Prepubertal onset is thought to be rare.

Objective

We sought to determine the prevalence of early-onset HS and to compare clinical characteristics between early-onset and normal-onset HS in a retrospective study.

Methods

Data were collected from 855 patients with HS. Early-onset HS was defined as onset before the thirteenth birthday. Clinical characteristics were analyzed in relation to the age of onset.

Results

In all, 66 patients (7.7%) reported early-onset HS. A family history for HS was significantly higher in early-onset patients (55.6% vs 34.2%; odds ratio 2.1, 95% confidence interval 1.2-3.6, P = .006). They developed inflammatory lesions at more body sites than patients with normal-onset HS (odds ratio 3.0, 95% confidence interval 1.8-4.9, P < .001). Distribution of the Hurley stages of severity showed no differences between the 2 groups (odds ratio 1.1, 95% confidence interval 0.7-1.8, P = .72).

Limitations

Some data were based on patient-reported information.

Conclusion

Early-onset HS occurs more frequently than previously believed. Patients with early-onset HS often report a family history for HS and develop lesions at more body sites.

Section snippets

Patients

We collected data from 855 patients given the diagnosis of HS between 2007 and 2014 in The Netherlands at the Department of Dermatology at the Erasmus University Medical Center, Rotterdam; the Deventer Hospital, Deventer; and the Department of Plastic Surgery at the Diaconessenhuis, Leiden. Data extraction took place partly from our HS database, also used by Schrader et al.5 For this type of retrospective analysis, no medical ethical committee approval is required under Dutch law.

Data collection

Patient

Results

A total of 620 women and 235 men, mean age 37.9 ± 12.8 years, were included (Table I). Body sites most frequently affected were the inguinal/genital (89.7%), axillary (64.3%), and gluteal (41.2%) areas. The (infra) mammary (20.7%), perianal (19.5%), and abdominal (16.7%) regions were least affected. Most patients were current smokers (70.5%) or ex-smokers (14.2%), who started smoking at a mean age of 16.1 ± 3.9 years.

Discussion

In this retrospective study of 855 patients, 66 (7.7%) reported early-onset HS. This is higher than previously reported (2%),7 indicating that early-onset HS is not so rare. Our results suggest that for HS, as with psoriasis and atopic dermatitis,9, 10 clinically different disease subsets can be distinguished based on age of onset.

In the early-onset group 56% reported a family history for HS, a higher proportion than the generally reported 35%.3, 11 This supports the findings of previous

References (13)

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Funding sources: None.

Conflicts of interest: None declared.

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