Treatment Outcomes in Older Adults With Hidradenitis Suppurativa: A Multimodal Approach

Studies of hidradenitis suppurativa (HS) in patients ≥ 60 years old are limited. Although multimodal therapy has been proposed as safe and effective, there is no consensus regarding optimal management in this population.

We conducted a retrospective review of 41 patients, aged ≥ 60 years, representing 6.7% (n = 616) of individuals receiving care at the Weill Cornell Dermatology Center for HS.

Among 41 older adults with HS, mean ( $\pm \mathrm{SD}$ ) age was 68.3 ± 5.3 years; 63% were female. Mean body mass index (BMI) was 31.3 ± 7.0 kg/m². Mean age of onset was 38.5 ± 18.6 years, with a diagnostic delay of 13.8 ± 17.1 years. At presentation, mean disease duration was 29.3 ± 19.9 years. More than half (51%) exhibited moderate-to-severe disease. In accordance with our treatment algorithm, all patients received multimodal therapy, comprised of antimicrobials (topical 100%, oral 88%, intravenous 20%), anti-androgens (83%), and anti-inflammatory drugs (71%). Among patients with longitudinal follow-up, there were significant decreases in HS-physician global assessment (HS-PGA; Δ-1.6), numerical rating scale for pain (NRS-pain; Δ-2.4), erythrocyte sedimentation rate (ESR; Δ-27.5 mm/h), C-reactive protein (CRP; Δ-10.9 mg/L), and interleukin-6 (IL-6; Δ-9.1 pg/mL). At most recent visit, 34 of 41 patients (83%) had clear-to-mild disease.

While previous reports emphasized the intractable nature of HS in older adults, our older patients experienced significant improvement of disease severity, pain scores, and inflammatory markers. These findings provide preliminary observational data regarding treatment outcomes in older adults with HS and warrant further investigation in larger prospective studies.