Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology

Abstract

Background. Hidradenitis suppurativa (HS) is a devastating chronic inflammatory skin disease with frequent recurrences. Various systemic treatments and procedures have been used but the efficacy of fractional microneedling radiofrequency (FMR) has not been reported. Aim. To evaluate the clinical and histological efficacy of FMR in the treatment of HS lesions.Methods. An 8-week, prospective, split-body, unblinded study was conducted, which enrolled 10 adult patients with mild to moderate HS to receive 3 sessions of FMR treatment biweekly. HS severity was assessed using the number and type of lesions, HS Physician Global Assessment (HS-PGA) and the modified Sartorius score (mSS). Skin biopsies were performed on participants to assess change in inflammation before and after FMR. Results. Severity of HS was significantly reduced on the FMR-treated side of the body, but not on the control side. Inflammatory HS lesions were significantly reduced after 4 weeks, while HS-PGA and mSS were significantly decreased after 6 weeks. Immunohistochemistry staining showed decreased expression of inflammatory markers including neutrophil elastases, interleukin (IL)-8 and IL-17, tumour necrosis factor-a, transforming growth factor-b1 and matrix metalloproteinases. Conclusion. FMR may be a viable treatment option for mild to moderate HS.

The efficacy and safety of endo‐radiofrequency for the treatment of hidradenitis suppurativa

“…which investigated the therapeutic effect of FMR on clinical and pathological aspects of HS patients showed that number of HS inflammatory lesions will be reduced after approximately one month while reduction in HS-PGA and modified Sartorius score (mSS) happens 6 months after the procedure. 5 In addition to clinical improvements, histopathological studies revealed significant reduction in inflammatory markers including IL-8, IL-17, TNF-α, TGF-β1, neutrophil elastases, and MMPs 5 . In a study by V Madan et al investigated the efficacy of carbon dioxide laser in recalcitrant severe hidradenitis suppurativa patients which were resistant to other medical or surgical therapies.…”

“…2,3,5 FMR is a method which utilizes microneedles to convey energy directly to the dermis. 5 Through FMR;…”

“…At the beginning of the study, patients’ demographic (gender, age and body mass index) and clinical (cigarette smoking, disease duration, drug history, and current treatment) information was prepared and recorded in the study checklist. In all patients, before the intervention, the initial grade of the disease was determined qualitatively based on HS physicians’ global assessment (HS‐PGA) that is an available method for determining the severity and extent of recovery in the disease 5 . The system describes six stages in HS, increasing in severity on a scale from one to six.…”

“…In all patients, before the intervention, the initial grade of the disease was determined qualitatively based on HS physicians' global assessment (HS-PGA) that is an available method for determining the severity and extent of recovery in the disease. 5 The system describes six stages in HS, increasing in severity on a scale from one to six. Post-treatment evaluation of patients with a 3-month observation period was performed on the basis of following description: (1) Determining the severity of the disease with HS-PGA by a blinded dermatologist (second grade), (2) The level of patient satisfaction: low response (less than 30%), moderate response (30%-50%), good response (50%-70%) and excellent response (above 70%), (3) The tolerability of each patient for the procedure (yes or no), and (4) Recording the probable complications of the intervention including erythema, heat, swelling, infection, and burning of the skin.…”

“…Radiofrequency (RF) in skin diseases is not only used for remodeling collagen fibers and rejuvenation, 9 but has also been used to treat acne vulgaris by affecting the sebaceous glands and in some studies to treat HS 3 . The therapeutic role of radiofrequency waves in HS has been reported to transfer heating into the derm and subsequent destruction of nodulocytic clinical lesions, as well as remodeling of collagen fibers, thus improving the patients’ fibrotic lesions 5 . Since there are few studies about efficacy and safety of this intervention, it is difficult for dermatologists and patients to decide on this method.…”