Abstract
IMPORTANCE: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by painful nodules in intertriginous regions that affects many pediatric patients. A significant proportion of patients with pediatric-onset HS may experience comorbidities, including metabolic and psychiatric disorders, adversely impacting their quality of life. OBJECTIVE: To evaluate the association between HS and relevant comorbidities in pediatric patients and determine the overall pooled prevalence of comorbidities in pediatric patients with HS. DATA SOURCES: Embase, PubMed/MEDLINE, and the Cochrane Central Register were searched on February 20, 2025, from database inception with no restrictions. STUDY SELECTION: Original investigations that reported on prevalence or association between pediatric HS and comorbidities were included. The search included key search terms for pediatric HS and different categories of comorbidities. Two independent authors performed screening and full-text review. DATA EXTRACTION AND SYNTHESIS: Extraction was done by 2 authors independently using a template. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. Data were pooled using random-effects modeling. MAIN OUTCOMES AND MEASURES: Meta-analyses of proportions were completed to estimate pooled prevalence rates, categorizing the data by specific comorbidities (obesity, overweight, anxiety, and others). RESULTS: A total of 19 studies, encompassing 17 267 pediatric patients with HS and 8 259 944 controls, were included. Pediatric patients with HS included in studies were predominantly female (mean of 76.7% [11 683 of 15 232]). The most prevalent comorbidities were 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). Multiple studies reported on the concurrence of pediatric HS and obesity or depression (GRADE: moderate certainty), and 3 studies reported an association with diabetes (GRADE: low certainty). CONCLUSIONS AND RELEVANCE: In this study, pediatric patients with HS had increased prevalence of chronic medical and psychiatric comorbidities, highlighting the potential benefit of a multidisciplinary approach.