Factors Such as Smoking, Late Onset Linked to Active HS in Patients Over 50

A variety of factors such as male gender, smoking, late disease onset, and specific phenotypes may be associated with active hidradenitis suppurativa (HS) for patients over the age of 50, according to recent findings.1

This new research was authored by a team led by L. Desmarest from the dermatology department of Erasme Hospital (HUB) in Belgium. The investigators noted that HS often manifests in patients around the age of 20, typically decreasing around the period of menopause and generally after age 50.

Despite such acknowledgements, Desmarest et al. noted that many dermatologists will interact with patients who may be over the age of 50 years that also report active HS. Given its prevalence, they sought to explore factors linked with active disease in this cohort.

“Despite the rising comorbidities in this age group, published data on patients older than 50 with active disease are limited,” Desmarest and colleagues wrote. “This study investigates HS-patients over 50, focusing on age of onset, phenotypes, severity and comorbidities.”1

Factors Associated with Active Disease for Patients with HS

The investigative team examined data on 583 individuals diagnosed with HS, utilizing data that was drawn from the European Registry for Hidradenitis Suppurativa (ERHS-Be) at Erasme Hospital in Brussels. There were 515 who had been under the age of 50 and 68 who were aged 50 or older.

The team conducted their statistical analyses of the ERHS-Be data were through SPSS software. They defined significance as P < .05.

During their analysis, it was noted that the older cohort's average agehad been 57.8 years, but those who were under the age of 50 showed a mean age of 31.5 years. The investigators further highlighted that women made up 62.5% of the younger arm of the study and 57.4% of the older arm.

Additionally, family HS history was observed among 35% of both age groups. Among those in the older age cohort, a notable delay in their HS diagnosis was identified, with average delays being 23 years versus the average 9-year delay seen in the younger cohort.

The research team determined that HS typically manifested later in the older group, as there had been an average onset at 29 years. This was compared to the average age of 18 years in the under 50 group.

While consistent body mass index (BMI) scores were observed by the team across both cohorts at approximately 28, they did find far greater smoking prevalence among those in the the older group. Specifically, it was found that 70% of older participants identifying as current smokers versus 56.9% of younger participants (P < .05).

Overall, the investigative team concluded that, despite the common belief that HS severity diminishes with age, there were no substantial differences identified between the 2 patient cohorts when evaluating disease severity using the Hurley and iHS4 scoring systems. Nevertheless, distinctions in affected areas and phenotypic presentations were noted.

They reported differences in Dudink phenotypes that had been significant (P < .05), adding that the older cohort more frequently presented with the ‘conglobata’ and ‘regular’ subtypes. Among those in the older cohort, a significant incidence increase of external anal, genital, and perianal involvement was seen.

The investigators further highlighted that arthritis and psoriasis had been more common among those in the older group, whereas migraines were more frequently reported in younger subjects. They also found that the prevalence of cardiovascular conditions such as hypertension, diabetes, and myocardial infarction, was greater among those in the older cohort.

Such conclusions may allow for greater insight into the presentation of HS in adults in older age brackets. The research team added that while HS is generally expected to improve with age, they found no significant reduction in disease severity among those over 50.

“In conclusion, this study suggests that factors such as late onset, male gender, specific phenotypes and smoking may be associated with active disease beyond the age of 50," they wrote. "It emphasizes the importance of early detection and aggressive treatment in this subset of HS-patients. Further research and multivariable analyses are needed to confirm these findings and specifically investigate late-onset HS patients.”1,2

References

1. Desmarest, L., Benhadou, F., Daoud, M., Sarkis, A.S., Heudens, S., Njimi, H., Karama, J., Suppa, M., White, J.M. and del Marmol, V. (2025), Hidradenitis suppurativa patients over 50 years old differ significantly from younger patients. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20577.
2. Van der Weijden DAY, Koerts NDK, van Munster BC, van der Zee HH, Horváth B. Hidradenitis suppurativa tarda: defining an understudied elderly population. Br J Dermatol. 2024; 190(1): 105–113.