Treatment of Patients with Down Syndrome and HS

May 23, 2024

This plain-language research summary was generated by AI, courtesy of HS Simplified.

AI Generated Content Verified By: Hal Flowers, MD, FAAD | University of Virginia

Treatment of Patients with Down Syndrome and HS

Individuals with Down syndrome (DS) are more likely to develop hidradenitis suppurativa (HS), a painful skin condition that involves blocked hair follicles. A 2024 study highlights that DS patients with HS may be undertreated due to concerns about medication side effects like those from biologics, which are drugs affecting the immune system. This underscores the need for tailored treatment approaches considering the challenges in this unique population.

Down Syndrome and Hidradenitis Suppurativa

People with Down syndrome (DS) can have a higher chance of getting certain skin problems, like hidradenitis suppurativa (HS). HS is a disease where painful bumps, abscesses, or tunnels form under the skin, usually in sweaty areas like the armpits and groin. These bumps can hurt a lot and are hard to treat.

Who Was in the Study?

A group of doctors looked back at medical records from two hospitals to find people who had both Down syndrome and HS. They found 43 patients. Most were not smokers, and the group had almost the same number of males and females. The average age when HS started was about 22 years old. Most people in the group were also overweight, with an average body mass index (BMI) of about 36 (BMI is a number that helps doctors know if someone is underweight, normal, or overweight).

Where Did HS Show Up?

The most common places for HS in these patients were the groin (67%) and armpits (65%). Other spots included the buttocks, legs, and the genital area.

How Was HS Treated?

Most people were given antibiotics—either creams for the skin or pills. Some got a medicine called adalimumab, which is a biologic (a medicine that changes how the immune system works). Others had surgery to remove the bumps or tunnels. However, only a few people tried adalimumab, because some patients or their caregivers were worried about side effects or didn't like the idea of regular shots.

Most people did not have bad reactions to the medicines. A few who took doxycycline (an antibiotic) had stomach problems and had to stop taking it.

What Did the Study Show?

This group of patients had some differences from people with HS who don't have Down syndrome. For example, their HS started at an older age, and they tended to be heavier. Most had milder HS, but some had more serious cases.

The doctors noticed that not many patients with Down syndrome and HS were given stronger treatments like biologics or surgery, even if their disease was bad. This could mean that people with Down syndrome might not always get all the treatments that could help them. One reason may be that families or doctors are worried about the safety of certain medicines, especially since people with Down syndrome have a higher risk for some cancers, like leukemia. However, the researchers point out that studies have not shown biologics to increase this risk.

Limitations

There are a few limitations with this study. The researchers looked back at old records, so some information was missing, like details about family history or exactly how severe each person’s HS was. Also, the study only included people treated at two hospitals, so the results might not be the same everywhere.

Why Is This Important?

This is the biggest study so far looking at HS in people with Down syndrome. It shows that many patients might not be getting the best treatment, and it’s important for doctors and families to learn more about safe and helpful options. Making sure people with Down syndrome understand their treatment and feel comfortable with it is also key.

More research is needed to find out which treatments work best and are safest for patients with both Down syndrome and HS.

Author(s)

Diem-Phuong D Dao, Catherine E Lyons, Aaron D Smith, Sara K Lamb, Haley B Naik, Richard Hal Flowers

Read Original Paper

https://onlinelibrary.wiley.com/doi/10.1111/ijd.17261