Pediatric Hidradenitis Suppurativa Severity not Linked to Obesity

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Pediatric and adolescent hidradenitis suppurativa (HS) severity does not correlate with obesity, according to new data that which contrasts findings from similar studies in adults.

In new data presented at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this weekend, investigators from the Mayo Clinic reported that despite young patients with HS and obesity being more likely to receive biologic therapy, they were not more likely to report more severe HS based on Hurley staging. In fact, patients with HS who were non-obese reported higher mean Hurley stage scores.

The investigators recommend that future research seeks to interpret when weight-related health becomes a factor in HS severity, as studies have established that adults with obesity face more severe HS.

The study team, led by Asfia Numani, BS, of the Mayo Clinic Alix School of Medicine, sought to address gaps in knowledge regarding associations between pediatric HS and high levels of body mass index (BMI) via the standard HS monitoring Hurley staging system. They additionally observed trends in the comorbidities and treatment strategies of young patients with HS, stratified by obese/non-obese status.

Indeed, HS is evidentially associated with comorbidities including metabolic and inflammatory disease. Though it’s often managed with a number of systemic therapies and invasive procedures in children and adolescents, the understood clinical characteristics of pediatric HS are less than that of adults.

“Adult HS severity is highly correlated with obesity (>30kg/m3 ), but this has not been established in the pediatric and adolescent population,” investigators wrote. “The disease mechanisms have not been fully elucidated in the adult or the pediatric form; this study hopes to address gaps in knowledge about the link.”

Numani and colleagues collected data from a cohort of patients observed at the Mayo Clinic Dermatology Department; eligible participants were born between 1992 – 2011 and diagnosed with HS prior to turning 18 years old. The team followed patients into adult, collecting information including Hurley staging of HS, number of treatments (biologics, medications, major incisions, and surgery), and comorbidities. Assessed comorbidities included:

• Hypertension
• Hyperlipidemia
• Psoriasis
• Irritable bowel disease
• Anxiety / Depression
• Thyorid disease
• Polycystic ovary syndrome

In the final assessment, investigators observed a mean Hurley stage score of 1.709 among non-obese children and adolescents with HS (n = 55), versus a mean score of 1.622 among obese children and adolescents with HS (n = 74), indicating more mean severe disease among non-obese patients (P = .675). However, obese patients were more likely to report more comorbidities (mean 1.265) from the identified list than non-obese patients (mean 0.832; P = .05).

Regarding therapies, the team observed that a higher rate of obese patients (n = 9 [18.4%]) were receiving biologic therapy for their HS than non-obese patients (n = 8 [6.1%]; P = .012).

“Obese patients tend to have more of the selected comorbidities, and it is not known whether this is due to the high BMI, inflammation from HS, or synergism from both factors,” investigators wrote. “None of these metrics varied between adolescent and pediatric patients.”

Though the analysis was limited by the lack of variability in the Hurley staging score, as well as the single-center retrospective design, investigators concluded that obesity was not demonstrated to correlate with pediatric nor adolescent HS disease severity. They additionally noted the lone treatment disparity between the obese and non-obese populations were a greater uptake of biologics among the former.

“Future directions will be to investigate when weight becomes an important factor in disease progression, including trends in birth weight and weight at diagnosis,” they wrote.

^Reference

^{Numani A, Ziebart R, Aghazadeh N, Todd A, et al. Associations between BMI, Disease Severity, Comorbidities, and Medications in Pediatric and Adolescent Hidradenitis Suppurativa Patients: A Cohort and Cross-Sectional Analysis. Paper presented at: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA.}