Dermatologists, other clinicians differ in pediatric hidradenitis suppurativa treatment

Key takeaways:

• Patients treated by dermatologists vs. non-dermatologists were much more likely to be prescribed biologics (19.7% vs. 0%).
• They were also more likely to receive intralesional steroids (40% vs. 0%).

Dermatologists are more likely to prescribe standard of care therapies to children with hidradenitis suppurativa compared with non-dermatologists, according to a study.

“Direct comparisons between the variety of specialties that manage pediatric [hidradenitis suppurativa (HS)] are lacking,” Kelly M. Atherton, MD, MSCR, of the college of medicine at the Medical University of South Carolina, and colleagues wrote. “We aim to identify differences in clinical management and treatment regimens for pediatric HS patients who are primarily managed by dermatology as compared with another specialty.”

Data from 195 patients aged 20 years or younger (80.5% female; 72.8% Black) with HS that were seen at the Medical University of South Carolina were included in this retrospective study.

Results showed that 76.1% of subjects saw a dermatologist for their condition at least once. Of these, 79.1% were referred by another provider — usually a pediatrician (43.2%) or family medicine physician (15.1%).

Of the remaining 47 patients that did not see a dermatologist, 42.6% were referred but were not seen due to canceling their appointment (47.8%) or simply never scheduling a visit (34.8%).

Of the HS diagnoses made, 36.6% came from dermatologists and 21.6% from pediatricians. Patients treated by dermatologists were much more likely than non-dermatology-treated patients to be prescribed standard of care therapies such as biologics (19.7% vs. 0%) and intralesional steroids (40% vs. 0%; P < .001).

However, they were equally likely to have incision and drainage (24% vs. 25.5%) and less likely to have surgical excision (13.3% vs. 25.5%; P = .04).

The authors also found that, when patients with HS are managed by dermatologists vs. non-dermatologists, they engage in a higher number of visits (3 vs. 2; P = .01) and experience longer management duration times (7.3 months vs. 0.77 months; P = .01).

“It remains to be seen whether this correlates with improved disease control and flare prevention,” the authors said.

Ultimately the authors found that dermatologists and non-dermatologists manage HS in children differently.

“Non-dermatologists tend to skip topical treatments, which may be effective as maintenance therapy,” the authors concluded. “Dermatologists prescribe more medications of all types to their HS patients and are more likely to prescribe biologic therapy.”