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    Pearls for treating hidradenitis suppurative in kids

    Early Tx important to slow progression, prevent surgery, ID social struggles


    15-year-old African-American female with Hurley stage II disease in the axillaeFor optimal treatment, the key is to catch the disease early on, according to Dr. Sayed. Patients with early stage disease benefit from Nd: YAG or other types of lasers that destroy the follicular unit. Dermatologists might also try antibiotics, birth control pills, spironolactone—things they’d frequently use in young, female acne patients, he says.

    “There are no approved biologics for HS in pediatric patients, but, in many cases, [biologic treatments] can be useful in the pediatric population, just as they are in adults,” Dr. Sayed says. “Adalimumab is the only biologic that’s approved for HS in adults. And there’s plenty of data on infliximab on adults, but they’re not specifically approved for pediatric HS.  Both are approved for other conditions in pediatric populations so we should feel safe using them in the HS population when the benefits outweigh the risks”

    The fact that the biologics aren’t approved for pediatric HS patients can lead to problems with insurance carriers’ covering the medications. These insurance approval problems often can be overcome, however, if dermatologists are willing to fight for the treatment, Dr. Sayed says.

    HS treatment success with first-line therapies is hit and miss, according to the dermatologist. When the disease is diagnosed early on, laser treatment can control it well.

    “But it’s not uncommon when the disease is very aggressive to have to go to second- and third-line treatments,” he says. “With young patients, they have such a long course of disease. If you have a 40-year-old patient or even a 25-year-old patient, they may be more likely to outgrow their disease in 5 to 10 years of their diagnosis. A lot of teenagers are going to have their disease for decades. Younger age of onset is also correlated with a more severe disease course.”

    Next: Lifestyle modifications as treatment

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.


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