Joslyn Kirby, MD, Shares OTC Product Benefits and HS Procedural Pearls

“When I'm using over the counter products, I feel like MacGyver. I'm using tools that are out there, but for a new purpose and usually high value, low cost, but good effect,” said Joslyn Sciacca Kirby, MD, MS, MEd, regarding her Fall Clinical session, “Leveraging OTC Products in Your Practice.” Kirby, a board-certified dermatologist, associate professor of dermatology, and vice chair for education in the dermatology department at Penn State Health, also presented at the 2023 Inflammatory Disease Summit on hidradenitis suppurativa (HS) procedures during breakout sessions.

During her OTC products presentation, Kirby reviewed some of her favorite products to recommend for improving itch, including OTC antihistamines, naltrexone taken with shelf-stable orange juice, and pimple patches.

Kirby’s HS workshop at the Inflammatory Disease Summit demonstrated the benefit of combining medications with procedures to better improve HS in various Hurley stages. In her interview, Kirby also discusses what’s coming up in the HS pipeline that clinicians should be paying attention to.

Transcript

Joslyn Sciacca Kirby, MD, MS, MEd: Hi, my name is Joslyn Kirby, I work at Penn State Health.

Dermatology Times: What products did you discuss in your Fall Clinical session, "Leveraging OTC Products in Your Practice?"

Kirby: We just had a conversation about OTC products and how you can leverage them for your practice. When I'm using over the counter products, I feel like MacGyver. I'm using tools that are out there, but for a new purpose and usually high value, low cost, but good effect. What's important to keep in mind is your patient might not see it that way. They just spent their time and money to come and see you as a provider in your office. Maybe they were looking for a prescription. So, anticipate that with just a little bit of guidance. One is see what their experience has been with OTCs and maybe that specific product. Second is set their expectations that this might actually have ingredients that can help them. When it comes to OTCs, I use a lot of them for itch and different ways that people feel itch. So first one is when it comes to chronic spontaneous urticaria, we're hearing so much more about CSU, but first line treatment is cheap, easy to use over the counter second generation antihistamines. So, these are cetirizine, fexofenadine, and loratadine. All of them are first line treatment, but at 4 times the daily dose. So not just one pill a day. Four pills a day is going to be your first tool for chronic spontaneous urticaria. Second, antihistamines don't put them away with urticaria pull them out when you have a procedure and somebody may be a little bit anxious. You can have diphenhydramine or Benadryl in your office, give it to people about 30 minutes before a procedure might help them feel just a little sedated a little more comfortable with that procedure. Other itches, sometimes we use low dose naltrexone. Now naltrexone is a prescription, but if you get it compounded it has a hefty price tag. You can use an over the counter tool, orange juice, shelf-stable orange juice, prescribe that naltrexone, there'sa really nice recipe in the JAAD in an article by Dirk Elston, I highly recommend you look it up. Last take home: pimple patches. So there's a new product on the market hydrocolloid patches that people can put on their acne, but in itch when people have prurigo nodularis, we need to interrupt that itch scratch itch cycle, I have them buy those pimple patches and put them on their prurigo nodules as a little reminder that we want to try and keep our fingers off.

Dermatology Times: Can you please provide an overview of the "Hidradenitis Suppurativa Hands-On Procedural Workshop" from the 2023 Inflammatory Disease Summit?

Kirby: We had an HS workshop the other day, we talked about medical management, but also importantly, the other side of things: procedural management. And I find that I move people further faster when I'm combining those 2 things together. So, for every stage of HS, there's a medicine you can use and a procedure that you can do. As the disease gets more advanced from Hurley 1 to Hurley 2 to Hurley 3, appropriately those medicines, they get a little more powerful. And the procedures, they might get a little bit bigger. These are all procedures we can do in our office. And so, one of the things we wanted to do is try and show people that they can do these procedures. So, we created a simulation during a workshop session, and we had people practice punch deroofings, more regular deroofings. And we talked about excisions.

Dermatology Times: HS treatment continues to gain momentum at meetings and in conversations. What is currently in the pipeline that you are looking forward to?

Kirby: HS, it's fun to see it as a hot topic of conversation not only in the hallways here at the conference, but up on the podium. And I think we're seeing a lot of data around new therapies that are coming out. We've had for years adalimumab, we use a lot of infliximab off-label, but now we're moving into the era of having some IL-17's in our toolbox for hidradenitis. Secukinumab is probably going to be labeled any day now for HS which will be great and hopefully decrease some of the work it takes us to get that drug for our patients. And then kind of close at its heels is going to be bimekizumab so a 17, and a TNF-α inhibitor. I'm really excited to have both of those in our toolbox. And a third drug class that we see coming along for HS is going to be JAK inhibitors and I think we're going to again, get people further faster and get better control with all these modalities.

[Transcript edited for clarity]