Pediatric Hidradenitis Suppurativa Linked to High Prevalence of Chronic Medical, Psychiatric Comorbidities

Pediatric patients with hidradenitis suppurativa have a significantly increased prevalence of chronic medical and psychiatric comorbidities, highlighting the critical need for comprehensive screening and multidisciplinary care. | Image Credit: Kristina Blokhin - stock.adobe.com

Pediatric patients diagnosed with hidradenitis suppurativa had an increased prevalence of chronic medical and psychiatric comorbidities, including obesity, acne vulgaris, and anxiety, underscoring the critical need for a multidisciplinary approach to care, according to a study published in JAMA Dermatology.¹

Hidradenitis suppurativa, also known as acne inversa, is a dermatologic condition that causes small, painful lumps to form under the skin that usually heal slowly, recur, and create tunnels and scars.² Symptoms commonly appear in areas where skin chafes, such as the armpits, groin, buttocks, and breasts. The disease presents a particular challenge in childhood due to its chronic nature, pain, frequent drainage, and foul odor, all of which interact with the developmental hurdles of late childhood and adolescence.¹

Additionally, pediatric hidradenitis suppurativa is associated with chronic comorbidities that can continue to impact overall quality of life (QOL). For example, obesity, hyperlipidemia, and anxiety affect approximately 34% to 93% of pediatric patients with the condition. Previous research also found that pediatric patients with hidradenitis suppurativa may experience gut microbiome dysregulation, which could link to mental disorders by directly modulating neural signals from the gut.³

To evaluate the association between hidradenitis suppurativa and comorbidity risk factors in pediatric patients, researchers conducted a systematic review and meta-analysis of observational studies.¹ They included 19 studies with 17,267 pediatric patients who had hidradenitis suppurativa and 8,259,944 controls. The studies predominantly featured more women (mean, 76.7%) than men, and the participants' mean age ranged from 12 to 17 years old.

Among pediatric patients with hidradenitis suppurativa, obesity emerged as one of the most prevalent comorbidities, affecting 6% to 59% (pooled proportion, 37%; 95% CI, 27-46) of this group. Only 1 study reported racial differences, finding that Black patients with hidradenitis suppurativa had a lower prevalence of obesity compared with those of other races. Overall, researchers concluded that hidradenitis suppurativa likely associates with increased obesity in pediatric populations.

Every study found that patients with hidradenitis suppurativa had a higher incidence or prevalence of depression compared with controls. The researchers concluded a probable association between hidradenitis suppurativa and depression in pediatric patients. Anxiety (ranging from 1.4% to 33.6%) and depression (ranging from 2.7% to 13.7%) were the most frequent psychiatric comorbidities. Acne vulgaris (pooled proportion, 43%; 95% CI, 21-65) appeared as the most frequent dermatologic condition in this population.

Overall, researchers identified acne vulgaris (pooled proportion, 43%; 95% CI, 21-65), obesity (pooled proportion, 37%; 95% CI, 27-46), anxiety (pooled proportion, 18%; 95% CI, 4-31), and hirsutism (pooled proportion, 14%; 95% CI, 6-21) as the most common comorbidities. Multiple studies reported on the concurrence of pediatric hidradenitis suppurativa with obesity or depression (GRADE: moderate certainty), and 3 studies found an association with diabetes (GRADE: low certainty).

Researchers graded several of the included studies as low quality, and most studies did not compare risks of comorbidities in pediatric patients with hidradenitis suppurativa with control groups, which created potential limitations. Significant heterogeneity existed between studies, though researchers attempted to minimize its effect by applying a random-effects model. Additionally, since most studies originated in the US, this may limit the generalizability of the findings to other populations.

“Our findings highlight a need for comprehensive comorbidity screening clinical guidelines in this population and emphasize the involvement of multidisciplinary teams to achieve this,” study authors concluded.

References

1. Mohsen ST, Price EL, Lara-Corrales I, Levy R, Sibbald C. Prevalence of comorbidities among Pediatric patients with hidradenitis suppurativa. JAMA Dermatol. Published online June 11, 2025. doi:10.1001/jamadermatol.2025.1565

2. Santoro C. Improving hidradenitis suppurativa outcomes by addressing treatment gaps. The American Journal of Managed Care^®. January 28, 2025. Accessed June 16, 2025. https://www.ajmc.com/view/improving-hidradenitis-suppurativa-outcomes-by-addressing-treatment-gaps

3. Santoro C. Pediatric hidradenitis suppurativa linked to gut microbiome dysregulation, mental health connections. The American Journal of Managed Care^®. May 28, 2025. Accessed June 16, 2025. https://www.ajmc.com/view/pediatric-hidradenitis-suppurativa-linked-to-gut-microbiome-dysregulation-mental-health-connections