Hidradenitis suppurativa in prepubescent and pubescent children

Hidradenitis Suppurativa (HS) is an uncommon disease, which is particularly rare in young and prepubescent children. HS pathology centers on the follicular unit and involves aberrant cutaneous cellular immunity. HS tends to first manifest in puberty, but a handful of prepubescent cases of HS have been reported and are linked to hormonal disorders, in particular elevated testosterone. The most common manifestations of HS are abscesses, scarring, acne inversa, and keloids, especially in the intertriginous areas of the groin and the axilla. Treatments including topical anti-infectives including chlorhexidine wash, topical clindamycin, tretinoin cream, and azelaic acid cream, which may be of limited use because bacteria involved in HS likely create biofilms. Oral agents include clindamycin with or without rifampin for short-term usage. Cases resistant to conservative therapy have been reported to respond to finasteride, onabotulinumtoxin, or microfractionated 10,600-nm CO2 laser.