Precocious Puberty More Common in Children with Hidradenitis Suppurativa

Amit Garg, MD

Credit: Northwell Health

Precocious puberty was identified more frequently among children and adolescents with hidradenitis suppurativa (HS) than those without a diagnosis, according to the results of a recent case-control study.¹

An analysis of the Explorys database, including more than 40 US healthcare networks, revealed pediatric patients with precocious puberty had a two-fold higher risk of HS, which remained after adjustment for demographic characteristics and body mass index (BMI).

“These findings are consistent with a small cross-sectional study from Europe and offer additional evidence to support the role of sex hormones in the pathophysiology of HS,” wrote the investigative team, led by Amit Garg, MD, department of dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

Sex hormones remain implicative in disease onset and activity in patients with HS.² An investigation into the link between HS and sex hormone disorders could benefit the understanding of HS pathophysiology and care, according to Garg and colleagues. They also noted that previous analyses reported a correlation between HS and androgen-mediated disorders, including polycystic ovarian syndrome and acne.³

For the current case-control study, patients aged 8–18 with ≥1 encounter and 12 months of observable person-time between March 2017 and February 2020 were included for analysis.¹ Cases of HS were identified using the International Classification of Disease 9th edition (ICD-9) codes.

The primary exposure for the analysis was defined as the diagnosis of precocious puberty on or before February 2020. Unadjusted and adjusted logistic regression models determined the association between HS and precocious puberty—the adjusted model included age, sex, race and ethnicity, and BMI category based on age- and sex-specific percentiles.

A total of 1605 patients with HS (82% female; mean age, 17 years) and 180,933 controls (49.5% female; mean age, 13 years) were identified for analysis. Among this population, precocious puberty was diagnosed in 40 patients with HS (2.5%) and 2120 controls (1.2%).

Upon analysis, the presence of precocious puberty was linked to increased risk of HS in both unadjusted (odds ratio [OR], 2.16; 95% CI, 1.57–2.96) and adjusted (OR, 2.13; 95% CI, 1.53–2.99) models. Garg and colleagues noted the adjusted OR remained similar in a complete case sensitivity analysis (OR, 2.33; 95% CI, 1.54–3.55).

In their summary, Garg and colleagues noted limitations of the analysis, including an incapacity to define the temporarilty of the association, surveillance bias favoring HS detection in precocious puberty, and the potential for misclassification of precocious puberty based on an unvalidated ICD code definition.

“Further exploration of the role of sex hormones and their dysregulation in the pathogenesis of HS is needed,” they wrote.

References

1. _{Mastacouris N, Midgette B, Strunk A, Garg A. Precocious Puberty Among Children and Adolescents With Hidradenitis Suppurativa. JAMA Dermatol. Published online September 18, 2024. doi:10.1001/jamadermatol.2024.3104}
2. _{Wertenteil S, Strunk A, Garg A. Overall and subgroup prevalence of acne vulgaris among patients with hidradenitis suppurativa. J Am Acad Dermatol. 2019;80(5):1308-1313. doi:10.1016/j.jaad.2018.09.040}
3. _{Garg A, Neuren E, Strunk A. Hidradenitis Suppurativa Is Associated with Polycystic Ovary Syndrome: A Population-Based Analysis in the United States. J Invest Dermatol. 2018;138(6):1288-1292. doi:10.1016/j.jid.2018.01.009}