Treatment Patterns in Pediatric Hidradenitis Suppurativa: Time to Treatment Initiation, Initial Treatment, and Time to Switching

BACKGROUND: Hidradenitis suppurativa (HS) causes significant morbidity in children. Treatment patterns across sex, race, and ethnicity in pediatric HS have not been thoroughly evaluated. We aim to characterize treatment patterns in pediatric HS, including (1) time to treatment initiation, (2) first prescribed HS treatment, and (3) time to switching following initial therapy across demographic factors. METHODS: We conducted a real-world, retrospective cohort study of patients < 18 years with a HS diagnosis, using a large U.S. national electronic health record database (2005-2025). Treatments prescribed within 1 year after HS diagnosis were categorized as systemic antibiotics, topicals, hormonal therapies, retinoids, biologics, or procedures. RESULTS: The cohort included 6659 children with HS (mean age 12.8 ± 2.8 years at diagnosis), 74.9% female, 37.7% White, and 56.5% non-Hispanic/Latino. Overall, 3.2% of children received biologics. Following HS diagnosis, the mean time to treatment initiation was 15 days. The most common initial treatment was systemic antibiotics plus topical therapies. The mean time on the initial treatment regimen prior to switching was 386 days. Multivariable analyses demonstrated that girls were more likely than boys to receive any treatments, including biologics, except major procedures. Non-White children initiated treatment sooner than White children (1 vs. 17 days, p < 0.0001). Regardless of demographic subgroup, most children remained on their initial HS treatment for a mean duration of approximately a year before switching therapies. CONCLUSION: Pediatric HS care is characterized by delayed treatment escalation, antibiotic-dominant initial therapy, and variation in treatment initiation timing across demographic groups.