An assessment of current practices in the treatment of hidradenitis suppurativa: the rise of biologic therapy.

INTRODUCTION: Treatments for hidradenitis suppurativa (HS) have changed in the last decade. In this context, we studied how management practices have shifted. METHODS: We analyzed the National Ambulatory Medical Care Survey (NAMCS) from 2010 to 2016 to assess current treatment practices for HS. RESULTS: There were 1.78 (95% confidence interval 1.35, 2.22) million visits. Antibiotics were observed at 55.7% of visits and observations remained stable over time (p = .9, odds ratio 0.99 [0.73, 1.3]). Pain medications were observed at 15.5% of visits and observations remained stable over time (p = .4, odds ratio [0.87 [0.61, 1.2]). Biologic agents were observed at 0.9% of visits and observations remained stable over time (p = .4, odds ratio 0.61 [0.21, 1.7]). Systemic immunomodulators were observed at 2.6% of visits and observations remained stable over time (p = .08, odds ratio 0.42 [0.12, 1.1]). 100% of biologic agents and 88% of systemic immunomodulators were prescribed by dermatologists. DISCUSSION: The use of biologic agents did not increase in this interval, but it is higher than in an earlier assessment of the NAMCS. Nearly all systemic immunomodulators are prescribed by dermatologists. The ambulatory uptake of these agents did not alter the use of other treatment modalities within this timeframe.

A Systematic Review of the Efficacy and Safety of Microneedling in the Treatment of Melasma.

BACKGROUND: Melasma is an acquired disorder of hyperpigmentation that is often recalcitrant to current therapies. Microneedling is used to treat scars, striae, and rhytides and has a relatively low risk of post-treatment dyspigmentation. Several studies have examined its use in melasma. OBJECTIVE: To review the published evidence on the efficacy and safety of microneedling in the treatment of melasma. METHODS: A systematic review was performed. A meta-analysis could not be performed because of methodological differences across studies and data heterogeneity. RESULTS: Eight studies were included for analysis. Most studies assessed the utility of microneedling in combination with other topical therapies and detected some success. However, microneedling-mediated transdermal delivery of medications is not superior to microinjections of medications. There is less evidence supporting the use of microneedling as monotherapy. Microneedling, when used with a 1064-nm Q-switched Nd:YAG laser, may provide additional benefit, although with a risk of post-treatment dyspigmentation. CONCLUSION: Based on low-quality evidence, microneedling may play a role in the treatment of melasma, with the mechanism of action likely being the facilitation of delivery of topical therapies to the epidermis and dermis, and one ancillary benefit of this approach being the very low risk of postinflammatory hyperpigmentation.