Hidradenitis suppurativa in paediatric patients with Down syndrome: a comparative study of 116 participants

BACKGROUND: Hidradenitis suppurativa (HS) seems to be more prevalent in patients with Down syndrome (DS), presenting with earlier onset and a higher incidence in girls and in association with an increased body mass index (BMI). OBJECTIVES: To describe the demographics, clinical characteristics and severity of HS in children with DS and make comparisons with children with DS alone. METHODS: We carried out a retrospective observational 5-year study of children (aged < 18 years) with DS at the Niño Jesús University Children's Hospital in Madrid, Spain. RESULTS: HS was diagnosed in 32 of 116 patients with DS. Median (interquartile range) age at onset in these patients was 13 (10-14) years, median BMI was 24.4 (21.0-26.5) kg m-² and 53% (n = 17/32) of the patients were girls. The most common phenotype was follicular HS (n = 15/32; 47%), and the majority (n = 27/32; 84%) had mild disease (Hurley stage I). The groin (n = 24/32; 75%) and buttocks (n = 21/32; 66%) were the most commonly affected areas. Treatment mainly involved topical and oral antibiotics, with 9% (n = 3/32) of the patients undergoing surgery. Significant differences were observed across phenotypes in sex distribution, HS lesion location and surgical rates. Our data indicate a higher BMI and greater association with the follicular occlusion tetrad in patients with DS and HS when compared with patients with DS alone. The limitations of this study include its retrospective nature, small sample size and data collection from a single centre. CONCLUSIONS: HS in children with DS is characterized by an early onset, higher BMI, predominance of the follicular phenotype and mild disease severity.