Metformin as Adjunctive Therapy for Pediatric Patients With Hidradenitis Suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder seen in adolescents and adults characterized by abscesses, sinus tracts and scarring, typically affecting intertriginous skin. Treatments often provide suboptimal control of the disease, and there are limited reports of therapies utilized in the pediatric population. There are no published guidelines or consensus for the treatment of pediatric HS. PURPOSE: To evaluate the clinical efficacy and safety of metformin as adjunctive treatment in adolescent patients with HS who have not responded to standard therapies at a single institution. RESULTS: Retrospective chart review identified 16 pediatric patients treated with metformin as adjunctive therapy for HS. Baseline scores were Hurley 1 in eleven (69%) and Hurley 2 in five (31%) patients. Follow-up visit data showed six (67%) patients were Hurley 1 and three (33%) patients were Hurley 2; five patients showed improvement on metformin with decreased frequency of flares, and five patients had no improvement. Six patients were lost to follow up or data was not available. Two patients discontinued metformin therapy due to side effects, including gastrointestinal distress and mood changes; the third patient discontinued due to lack of improvement. Two patients had mildly elevated liver transaminases prior to metformin initiation which improved while on metformin therapy. DISCUSSION: For some pediatric patients, metformin as an adjunctive therapy may help improve control of HS with minimal side effects. Adequately designed and controlled studies are needed to further evaluate the role of metformin, and efficacy, tolerability and safety in the pediatric HS patients. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5447.

Lice update: new solutions to an old problem.

An estimated 6 to 12 million children are affected by lice annually in the United States.(1) Knowledge of the various treatment options for this diagnosis is essential. This paper aims to provide an overview of the myriad therapeutic options available for lice infestations in children. U.S. Food and Drug Administration-approved drugs, off-label drug therapies, over-the counter-products, and herbal remedies are all discussed in detail. Clinicians may use this information to teach patients and families about the latest available care for the eradication of head lice in pediatric patients.