Hidradenitis Suppurativa Causes Psychosocial Impact in Children

Posters presented at the Society for Pediatric Dermatology Annual Meeting, taking place from July 11 to July 14, 2024, in Toronto, Ontario, Canada, found that hidradenitis suppurativa was a cause of psychosocial distress in children with the condition. Deroofing in childhood was found to lead to positive patient satisfaction later in life.

Hidradenitis suppurativa is a skin condition that causes painful lumps to form deep within the skin. Underarms, inner thighs, and the groin area are just some of the spots where these lumps can occur, as all lumps form in areas where skin touches the skin.¹ Hidradenitis suppurativa can negatively affect a patient’s quality of life, as it can be hard to even sit with these lumps forming on their inner thighs.

Hidradenitis suppurativa can affect a child psychosocially but deroofing may provide some relief | Image credit: Lea - stock.adobe.com

The first poster² focused on the psychosocial effects on adolescents with hidradenitis suppurativa. This study was conducted using various different surveys to collect information on quality of life, body appreciation, bullying, friendships, loneliness, pain behavior, life outlook, anxiety, depression, and family belonging. The survey was distributed to adolescents who were aged between 10 and 19 years who were seen at the UNC Department of Dermatology.

There were 36 patients who completed the survey who had a mean age of 16.6 years; the patients mostly identified as white (58.3%) or black (41.7%) and most of the participants were young women (75.0%). The mean score on the Hidradenitis Suppurativa Quality of Life Scale (HisQOL) was 13.6/68. The subscale scores for symptoms (5.2/16), psychosocial impact (3.0/20), and activities-adaptation (5.5/32) indicated that drainage, odor, pain related to HS, and itch were the biggest detriments to QOL in the adolescents. Patient-Reported Outcome Measurement Information System (PROMIS) pain scores indicated mild pain among the adolescents.

Overall body positivity was high in adolescents, with a mean body appreciation scale score of 38.9/50. Only some patients reported never feeling good about their body with a 6/36 score. Moderate loneliness was reported, with a mean UCLA Short-Form Adolescent Loneliness Scale score of 13.7/32. The PROMIS anxiety score was 16.1/40, and the PROMIS depression score was 15.7/40. Bullying was rare in patients, as only 2 patients reported getting made fun of for bleeding or drainage from their hidradenitis suppurativa. However, 22 of the participants reported both hiding their skin at school and not participating in physical education. A total of 16 of the patients felt comfortable talking about their hidradenitis suppurativa with a small group of friends. Strong family support was also reported.

Some limitations of this analysis included the cross-sectional design of the study as well as the variable nature of a participant’s perception of the impact of hidradenitis suppurativa on their psychosocial well-being. Future studies should focus on interventions that help reduce the long-term effect of hidradenitis suppurativa on the well-being of adolescents.

The second poster³ focused on just 1 of the ways that the long-term effect of hidradenitis suppurativa can be reduced. Although patients can be treated for hidradenitis suppurativa using different medical treatments, deroofing, a surgical treatment, is another method to treating hidradenitis suppurativa in pediatric patients. This study aimed to assess how satisfied adult patients were with receiving a deroofing procedure while they were adolescents.

A survey containing 23 questions was given to patients from pediatric and adult dermatology clinics at the dermatology institution at the University of Texas at Austin Dell Medical School who had a deroofing procedure when they were aged 18 years or younger. The surveys were collected between September 2022 and May 2023.

There were 9 participants in the survey who had a mean age of 16 years. Most of the patients (78%) were not worried or anxious about having a complication from the procedure, but 45% reported feeling moderate or extreme anxiety for the procedure itself. Patients rated their pain during the surgery as a mean of 2.7 out of 10, but 8 of the 9 agreed that the pain from a hidradenitis suppurativa flare was worse.

A total of 33% reported that the surgery was moderately to extremely difficult to recover from and the mean time spent on wound care was 27 minutes a day for the first few weeks after the surgery. The hidradenitis suppurativa surgery interfered with school a lot for 67% of the patients, as most did not return to activities for 6 weeks after the surgery. With that, 7 of the patients were somewhat to extremely satisfied with the surgery and would recommend the surgery to another person with hidradenitis suppurativa.

Most of the patients reported feeling satisfied with their deroofing surgery, even though these results require confirmation with more pediatric patients and with an expanded number of participants. The results of the 2 posters demonstrate that even though hidradenitis suppurativa can affect a pediatric patient psychosocially, deroofing can be an effective long-term treatment to help patients with hidradenitis suppurativa.

References

1. Ludmann P. Hidradenitis suppurativa: overview. American Academy of Dermatology Association. Updated May 3, 2022. Accessed July 12, 2024. https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview
2. Shams RB, Patidar SM, Sayed CJ. Social impact of hidradenitis suppurativa among adolescents. Presented at Society of Pediatric Dermatology Annual Meeting; July 11-July 14, 2024; Toronto, Ontario, Canada. Abstract 118
3. Nguyen C, Haller CN, England ME, Diaz LZ, Peña-Robichaux V. Pediatric satisfaction after deroofing surgery for hidradenitis suppurativa. Presented at Society of Pediatric Dermatology Annual Meeting; July 11-July 14, 2024; Toronto, Ontario, Canada. Abstract 114