Treating Tick borne infections

Insights From the Field: Treating Lyme Disease and Other Tick- Borne Illnesses Allison Nguyen; Nikki Kean | April 3, 2026 Vanessa Pomarico-Denino, EdD, APRN, FNP-BC, FAANP, contracted Lyme disease and babesiosis not while out in the woods, but while sitting on the paved patio in her mother’s backyard. At the same time, her mother was critically ill in the hospital, being treated for a tick-borne illness. Dr Pomarico-Denino, a nurse practitioner (NP) living in Connecticut, draws on her personal experience and clinical expertise to educate others on the treatment and prevention of tick-borne illnesses. She serves as the lead clinician for diversity, equity, inclusion, and belonging for the Northeast Medical Group and teaches for Fitzgerald Health Education Associates, which has been educating NPs for 32 years. With the rise in Lyme disease cases in the United States, it is increasingly important for health care professionals to stay current with the latest treatment recommendations. 1 In addition, Dr Pomarico-Denino urges clinicians to test and treat for the other 3 most common tick-borne illnesses: babesiosis, ehrlichiosis, and anaplasmosis. “Patients can typically be infected with more than one type of infection. If you test just for Lyme disease, you are missing other infection(s).” Epidemiology of Lyme Disease in the United States https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 1 of 8Lyme disease first became a nationally notifiable condition in the US in 1991. According to the Centers for Disease Control and Prevention (CDC), approximately 476,000 people in the country are diagnosed and treated for Lyme disease annually. 1 This estimate includes patients treated based on clinical suspicion of Lyme disease. In 2023, over 89,000 cases of Lyme disease were reported to the CDC by state health departments and the District of Columbia, representing a significant increase from the 2019 to 2022 average of 46,115 cases. 2 While a portion of the increase in cases is attributed to changes in surveillance methods, Lyme disease remains the most common tick-borne illness in the US. 3,4 Dr Pomarico-Denino said that this approximation is likely an underestimate, saying that “not all patients report cases unless they’re getting sick. Patients often come in with different complaints, but since this disease is always on my radar, I’ll run the blood work, and it sometimes shows they’ve had an old Lyme infection that may or may not have been treated.” Factors contributing to the increase in rates of Lyme disease include climate change and changes to human behavior, such as spending more time outdoors, which began during the COVID-19 pandemic. “I was taking ticks off of people all winter long because we didn’t have a prolonged, cold, hard frost [in the Northeast],” said Dr Pomarico-Denino. Climate change has also expanded the geographic range of ticks, allowing them to survive in environments that were previously inhospitable. 5 Ticks live on deer, rodents, birds, and other animals. In the US, Lyme disease and babesiosis, ehrlichiosis, and anaplasmosis are significantly more common in the Northeast, mid-Atlantic, and upper Midwest areas than in other regions of the country. 5 Guideline-Recommended Lyme Disease Treatment The CDC-recommended treatment regimens for Lyme disease align with the latest guidelines from the Infectious Diseases Society of America (IDSA) for the treatment of tickborne diseases. 6,7 In summation, the guidelines state that the recommended duration of therapy is 10 to 14 days for early Lyme disease, 14 days for Lyme carditis, https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 2 of 814 to 21 days for neurologic Lyme disease, and 28 days for late Lyme arthritis. “ The treatment for Lyme is doxycycline, which also covers ehrlichiosis and anaplasmosis, but babesiosis is treated with atovaquone plus azithromycin for at least 7 to 10 days, according to the CDC. ” Vanessa Pomarico-Denino, EdD, APRN, FNP-BC, FAANP There is some controversy regarding doxycycline administration in pediatric patients, noted Dr Pomarico-Denino. “Doxycycline is contraindicated in anyone under the age of 8 because of the risk of permanent tooth staining unless the infection is life-threatening, then the benefit outweighs the risk,” she said. “If doxycycline is used in children, the dose is 4.4 mg/kg with a maximum dose of 200 mg.” Recent studies state that doxycycline can be safely administered for short durations regardless of patient age. IDSA Treatment Guidelines for Tick-Borne Illnesses Tick-Borne Illness Treatment Treatment Duration Lyme Disease (Borrelia burgdorferi) Patients with high-risk a Ixodes scapularis bites in all age groups Oral doxycycline (200 mg) Single 200 mg dose within 72 hours of tick removal over observation Patients with erythema migrans Oral antibiotic therapy with doxycycline, amoxicillin, or cefuroxime axetil 10-day course of doxycycline, a 14-day course of amoxicillin, or cefuroxime axetil Anaplasmosis (Anaplasma phagocytophilum) Oral doxycycline 10-14 days Outpatient: Oral https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 3 of 8Babesiosis (Babesia microti) atovaquone 750 mg BID plus oral azithromycin 500 mg on day 1, then 250 mg for 7-10 days Inpatient: More severe disease requires 500-1000 mg of azithromycin daily 7-10 days Ehrlichiosis (Ehrlichia chaffeensis, E. ewingii, or E. muris eauclairensis ) Oral doxycycline 7-14 days, or until fever resolves a A tick bite is considered high risk only if it meets the following 3 criteria: the tick bite was from (a) an identified Ixodes spp. vector species, (b) it occurred in a highly endemic area, and (c) the tick was attached for ≥36 hours. Dr Pomarico-Denino said that the vast majority of patients are unable to determine how long a tick has been attached, so many providers typically prescribe a single- use dose of doxycycline as a precautionary measure. After treatment with doxycycline, it is recommended that patients follow up with their provider if symptoms of Lyme disease develop. These symptoms include erythema migrans (also commonly referred to as a bull’s-eye rash), flu-like symptoms, and severe headaches. 8 “Only about 70% of people with Lyme infections get a rash, and 30% don’t ever get a rash or they get a rash in an area that you wouldn’t see it,” said Dr Pomarico-Denino. “If patients develop symptoms like this, then we test them sooner and start them on a longer course of doxycycline. We no longer immediately put people on 3 weeks of doxycycline because of one bite, because not all ticks are infected.” Read more: Leptospirosis Approach to Treating Coinfections with Lyme Disease https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 4 of 8While patients with Lyme disease usually respond to antibiotic treatment, approximately 10% to 20% of reported patient cases experience continued symptoms despite treatment. Of these patients, approximately 50% will experience a coinfection, requiring a reevaluation of the treatment approach. 9,10 “Ticks can carry more than one kind of infection, and patients are often infected with more than one type of infection,” Dr Pomarico-Denino said. “The treatment for Lyme is doxycycline, which also covers ehrlichiosis and anaplasmosis, but babesiosis is treated with atovaquone plus azithromycin for at least 7 to 10 days, according to the CDC.” Depending on the type of coinfection, the treatment approach for Lyme disease can differ. “Babesiosis can be significantly more life-threatening, especially if a patient’s parasite count increases and if they are elderly,” noted Dr Pomarico-Denino. “Many patients are hospitalized if they have other comorbid conditions, so we typically treat all conditions at the same time. But again, the treatment approach would change based on the patient,” she said. “Do I want to treat babesiosis the first week and then start the doxycycline? Or are we going to treat them all at the same time?” Preventing Tick Bites Per the IDSA guidelines, personal protective measures for preventing tick bites and tick-borne infections include N, N-diethyl-meta-toluamide (DEET), picaridin, ethyl-3- (N-butyl-N-acetyl) aminopropionate (IR3535), oil of lemon eucalyptus (OLE), p- methane-3,8-diol (PMD), 2-undecanone, or permethrin. “Permethrin comes in a spray that patients can spray on their clothing,” says Dr Pomarico-Denino. “We tell them not to put it on their skin since it’s very caustic, but they can put it on their shoes, hiking gear, hats, and backpacks. It lasts through 5 or 6 washings. They can get that at any garden center or order it on the permethrin website.” From Dr Pomarico-Denino’s personal experience living in a highly endemic area for https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 5 of 8ticks, some additional recommendations she has include tucking in clothing, wearing hats, and conducting a thorough skin survey once you have returned home. A recommendation for patients who are avoiding chemical repellents includes using essential oils (eg, a mixture of thyme, citronella, and oregano oil) as a tick deterrent, although limited data support this approach. There are currently no vaccines available for Lyme disease. LYMERix ® , the only vaccine previously available in the US, was discontinued in 2002 because of low demand. One vaccine candidate, VLA15, is currently in Phase 3 clinical trials. Additionally, a human monoclonal antibody for pre-exposure prophylaxis (PrEP) for Lyme disease is expected to begin human trials soon. 11 Hear directly from Dr Vanessa Pomarico-Denino as she reminds clinicians to be on the lookout for lesser-known tick-borne infections, especially during the warmer months: This article originally appeared on Clinical Advisor References: 1. Lyme Disease Surveillance and Data. Centers for Disease Control and https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 6 of 82. 3. 4. 5. Prevention. Published March 13, 2025. Accessed August 2, 2025. https://www.cdc.gov/lyme/data-research/facts-stats/index.html Tickborne Disease Surveillance Data Summary. Published July 15, 2024. Accessed August 2, 2025. https://www.cdc.gov/ticks/data-research/facts- stats/tickborne-disease-surveillance-data-summary.html Kugeler KJ, Earley A, Mead PS, Hinckley AF. Surveillance for Lyme disease after implementation of a revised case definition — United States, 2022. MMWR Morb Mortal Wkly Rep. doi:10.15585/mmwr.mm7306a1 Nathavitharana RR, Mitty JA. Diseases from North America: focus on tick- borne infections. Clin Med (Lond) . doi:10.7861/clinmedicine.14-6-74 Climate Change Indicators: Lyme Disease. Environmental Protection Agency. Updated on June 13, 2025. Accessed August 3, 2025. https://www.epa.gov/climate-indicators/climate-change-indicators-lyme- disease 6. 7. 8. 9. 10. Clinical Care of Lyme Disease. Centers for Disease Control and Prevention. Published May 15, 2025. Accessed August 2, 2025. https://www.cdc.gov/lyme/hcp/clinical-care/index.html Lantos PM, Rumbaugh J, Bockenstedt LK, et al. AAN/ACR/IDSA 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis . Published November 30, 2020. Accessed August 2, 2025. doi:10.1093/cid/ciaa1215 Signs and Symptoms of Untreated Lyme Disease. Centers for Disease Control and Prevention. Published May 15, 2024. Accessed August 2, 2025. https://www.cdc.gov/lyme/signs-symptoms/index.html Melia MT, Auwaerter PG. Time for a different approach to Lyme disease and long-term symptoms. N Engl J Med. Published March 31, 2016. doi:10.1056/NEJMe1502350 Johnson L, Wilcox S, Mankoff J, Stricker RB. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. PeerJ. Published March 27, 2014. doi:10.7717/peerj.322 https://www.dermatologyadvisor.com/features/treating-lyme-dis903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:22 AM Page 7 of 811. Lyme Disease Vaccine. Centers for Disease Control and Prevention. Published December 17, 2024. Accessed August 2, 2025. https://www.cdc.gov/lyme/about/lyme-disease-vaccine.html Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.

Rosacea Signos y Sintomas

Rosacea: Signs and Symptoms Colleen Stanton | April 17, 2026 Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers. Rosacea is a chronic inflammatory skin condition that causes redness, flushing, visible blood vessels, and small bumps on the face. 1 It most commonly affects the cheeks, nose, chin, and forehead. Rosacea tends to develop gradually. Many people first notice frequent flushing or blushing, which may later become persistent redness. Over time, additional symptoms such as visible blood vessels or acne-like bumps may appear. Although rosacea can affect anyone, it is most commonly seen in adults aged 30 to 50 years and is more frequently diagnosed in patients with fair skin. 2 However, it can occur in all skin types. While rosacea is not life-threatening, it can be a significant source of frustration or discomfort and negatively affect patients’ self-esteem, reducing overall quality of life. Signs and Symptoms of Rosacea Rosacea presents differently from person to person. Some patients may have only mild redness, while others experience more pronounced symptoms. Symptoms often flare up and then improve, rather than remaining constant. 3 Common signs and symptoms include the following: https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 1 of 10Common signs and symptoms include the following: Persistent facial redness, especially across the cheeks and nose; Flushing or blushing that occurs easily and frequently; Visible blood vessels; Small red bumps or pus-filled pimples; Burning, stinging, or sensitive skin; and Dry, rough, or swollen skin. More advanced cases may involve thickened skin, particularly on the nose, as well as ocular symptoms, including eye irritation, redness, or dryness. Types of Rosacea Rosacea is often grouped into subtypes based on the dominant symptoms, which guides treatment. Erythematotelangiectatic Rosacea (ETR) This type is characterized by persistent redness and visible blood vessels. Flushing is common and may worsen over time. Representing more than 50% of cases, ETR is the most prevalent form of rosacea. 1,4 Papulopustular Rosacea Often mistaken for acne, this type includes red bumps and pus-filled lesions along with background redness. Papulopustular rosacea accounts for about 43% of 3,4 cases. Ocular Rosacea https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 2 of 10Ocular Rosacea This form of rosacea involves inflammation of the ocular surface and eyelids, causing dryness, irritation, redness, and a gritty or burning sensation. It may occur on its own or alongside the more familiar skin symptoms of facial rosacea. 4,5 In some cases, eye symptoms can appear before skin changes develop, which can make ocular rosacea more difficult to recognize. Because the eyes are sensitive, even mild inflammation can lead to noticeable discomfort. Phymatous Rosacea This rarer type of rosacea leads to thickened, bumpy skin. It most commonly is seen on the nose and in men. Phymatous rosacea makes up about 7% of rosacea cases. 1,4 What Causes Rosacea? The exact cause of rosacea is not fully understood, but it is believed to involve a combination of factors. 2 Previous research has found that rosacea symptoms could be equally attributed to genetic and environmental factors. 6 Possible contributing factors include increased sensitivity of facial blood vessels, an overactive immune system, genetic predisposition, environmental triggers, and microorganisms on the skin such as Demodex mites. 5,6 Rosacea is not contagious and is not caused by poor hygiene. Common Triggers for Symptom Flares Many people with rosacea notice that certain factors trigger or worsen their symptoms. Identifying personal triggers is an important part of managing the condition. Common triggers include sun exposure, hot weather or cold wind, eating spicy https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 3 of 10foods, drinking alcohol (particularly red wine) or hot beverages, stress, emotional changes, exercise, and use of skin care products that irritate the skin. 1,6 Not all triggers affect everyone, so it can be helpful to track what seems to worsen your symptoms. Rosacea Diagnosis Rosacea is typically diagnosed through a clinical evaluation by a health care provider. There is no single test for rosacea. 1 During an evaluation, your provider may begin with examining your skin. They will ask for a complete medical history and will discuss triggers as well as symptom patterns. Early diagnosis can help prevent progression and make symptoms easier to manage. In some cases, additional testing may be done to rule out other skin conditions that can mimic rosacea. Distinguishing Rosacea From Other Skin Conditions Rosacea is often mistaken for other skin concerns. Understanding the differences can help you seek appropriate care. https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 4 of 10Rosacea vs Other Redness Farshchian M, Daveluy S. Rosacea. StatPearls Publishing; 2023. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557574/ Rosacea vs Acne Rosacea and acne can look similar because both may involve red bumps and breakouts. However, redness and flushing are more prominent in rosacea, and patients may experience skin sensitivity or burning. Acne, on the other hand, commonly includes clogged pores, blackheads, and whiteheads. Acne affects a wider range of areas, including the back and chest. 7 Rosacea vs General Facial Redness Some people naturally have facial redness or flushing, but rosacea tends to be more persistent and progressive. With rosacea, redness may worsen over time. Visible blood vessels may develop, and additional symptoms such as bumps or irritation often occur. Simple redness without these features is less likely to be rosacea. https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 5 of 10Rosacea vs Eczema Eczema can also cause redness and irritation, but it typically presents differently. Patients with rosacea often experience burning or stinging, whereas eczema causes intense itching. Skin in patients with eczema may appear dry, cracked, or scaly. Eczema may affect areas beyond the face, such as the arms or behind the knees. While patients with some types of rosacea and eczema may both experience thickened skin, this symptom in patients with eczema is usually the result of itching and rubbing. 8 Rosacea vs Lupus Rash Another inflammatory disorder with skin symptoms that may be mistaken for rosacea is subacute cutaneous lupus erythematosus. This condition includes a butterfly-shaped rash across the cheeks and nose. Subacute cutaneous lupus erythematosus is associated with lupus, an autoimmune condition. Lupus rash is usually accompanied by other systemic symptoms, such as fatigue or joint pain, whereas rosacea symptoms are typically limited to the skin and eyes. Both conditions may cause visible blood vessels. 9 Managing Rosacea While rosacea cannot be cured, it can be effectively managed with the right approach. Treatment plans are tailored to each patient based on symptoms and disease severity. Management may involve gentle skin care products, over-the- counter topical treatments, antibiotics, laser and light therapy, and lifestyle modifications such as reducing sun exposure and alcohol intake. 10 Many people successfully manage their symptoms with a combination of medical care and lifestyle changes. https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 6 of 10lifestyle changes. Skin Care Strategies Gentle skin care is essential for people with rosacea. Recommendations include using mild, fragrance-free cleansers, avoiding harsh exfoliants or scrubs, and choosing products labeled for sensitive skin. Patients should apply a daily, broad- spectrum sunscreen with an SPF of 30 or higher. Consistency is key, and introducing new products slowly can help prevent irritation. 10 Medical Treatments A health care provider may recommend prescription or in-office treatments to help control symptoms. Options may include the following: Topical medications to reduce redness and inflammation; Oral medications, such as antibiotics, for more severe cases; Laser or light-based treatments to reduce visible blood vessels and flushing; and Topical eye drops or ointments for ocular rosacea; Treatment plans are often adjusted over time depending on how your skin responds. 10 Lifestyle Modifications Managing triggers plays an important role in reducing flare-ups. Helpful strategies include keeping a diary to identify personal triggers and practicing stress management techniques. Limiting exposure to extreme temperatures as well as using sunscreen or protective clothing outdoors may also help. Small adjustments can make a significant difference in symptom control. 10 https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 7 of 10When to See a Health Care Provider It is a good idea to seek medical advice if you: Notice facial redness that does not improve Experience frequent flushing or sensitivity Develop acne-like bumps that do not respond to over-the-counter treatments Have eye symptoms such as dryness or irritation Early evaluation can help confirm the diagnosis and prevent symptoms from worsening. Frequently Asked Questions Can rosacea go away on its own? Rosacea is a chronic condition, meaning it does not usually go away completely. However, symptoms can be controlled and improved with proper treatment and lifestyle adjustments. 3 What is the biggest trigger for rosacea? There is no single trigger that affects everyone. Common triggers include sun exposure, heat, alcohol, spicy foods, and stress. Identifying your personal triggers is key. 3 Can makeup make rosacea worse? https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 8 of 10Some makeup products may irritate sensitive skin. Choosing non-irritating, fragrance-free products designed for sensitive skin can help minimize flare-ups. 11 Can makeup disguise rosacea? For anyone with a desire to use makeup, choosing the correct products is important. Many dermatologists recommend water-based or powder makeup as these products are less likely to cause skin irritation. Makeup with a yellow tint may hide discoloration and a green tint may hide redness. 11 Is rosacea dangerous? Rosacea is not dangerous, but it can worsen over time if untreated. In some cases, it can affect the eyes or lead to thickened skin. Early management helps prevent complications. 1 Download this fact sheet as a PDF. 1. 2. 3. 4. References Farshchian M, Daveluy S. Rosacea. StatPearls Publishing; 2023. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557574/ van Zuuren EJ, Arents BWM, van der Linden MM, Vermeulen S, Fedorowicz, Tan R. Rosacea: new concepts in classification and treatment. Am J Clin Dermatol. 2021;22(4):457-465. doi:10.1007/s40257-021-00595-7 Rainer BM, Kang S, Chien AL. Rosacea: epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):e1361574. doi:10.1080/19381980.2017.1361574 Barakji YA, Rønnstad ATM, Christensen MO, et al. Assessment of frequency of rosacea subtypes in patients with rosacea: a systematic review and meta- analysis. JAMA Dermatol. 2022;158(6):617-625. doi:10.1001/jamadermatol.2022.0526 https://www.dermatologyadvisor.com/factsheets/rosacea-signs-903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:19 AM Page 9 of 105. 6. 7. 8. 9. 10. 11. doi:10.1001/jamadermatol.2022.0526 Mohamed-Noriega K, Loya-Garcia D, Vera-Duarte GR, et al. Ocular rosacea: an updated review. Cornea. 2025;44(4):525-537. doi:10.1097/ICO.0000000000003785 Aldrich N, Gerstenblith M, Fu P, et al. Genetic vs environmental factors that correlate with rosacea: a cohort-based survey of twins. JAMA Dermatol. 2015;151(11):1213-1219. doi:10.1001/jamadermatol.2015.2230 Sutaria AH, Masood S, Saleh HM, Schlessinger J. Acne vulgaris. StatPearls Publishing; 2023. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK459173 Nemeth V, Syed HA, Evans J. Eczema. StatPearls Publishing; 2024. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK538209 Jatwani S, Hearth Holmes MP. Subacute cutaneous lupus erythematosus. StatPearls Publishing; 2024. Accessed March 31, 2026. https://www.ncbi.nlm.nih.gov/books/NBK554554 Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501-1510. doi:10.1016/j.jaad.2020.01.077 Ludmann P. 7 rosacea skin care tips dermatologists recommend. American Academy of Dermatology. Updated April 3, 2024. Accessed April 16, 2026. https://www.aad.org/public/diseases/rosacea/triggers/tips Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.

HS nd pregnancy

Managing Hidradenitis Suppurativa in Pregnancy Tori Rodriguez, MA, LPC | May 1, 2026 Significantly more women than men develop hidradenitis suppurativa (HS), with a majority of cases occurring among patients of reproductive age. 1 Pregnancy and the postpartum period presents additional challenges in the management of patients with HS due to associated adverse events and increased complexity of therapeutic regimens. Research exploring the relationship between HS, pregnancy, and the post-partum period has begun to gain momentum. Studies have emerged examining HS and associated maternal and fetal outcomes, guidelines were developed on treatments specific to pregnant and breastfeeding patients, and more attention has been given to patient desires for family planning than ever before. Recent Findings on Pregnancy Outcomes in HS Across numerous studies, HS has been linked to a range of adverse events in both pregnancy and childbirth. “Pregnant mothers with HS are at higher risk for hypertension, gestational diabetes, cesarean delivery, severe maternal morbidity, preterm birth, and birth defects compared with those without HS,” explained Chris Adigun, MD, founder of the Dermatology and Laser Center of Chapel Hill. 1 https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 1 of 6“ Given how common this condition is and the significant impact it has on pregnancy and neonatal outcomes, there is a need for further research and ” investigation. A population-based longitudinal study published in 2024 found an increased risk for the following outcomes among patients with HS compared with patients without HS: Severe maternal morbidity (risk ratio [RR], 1.38; 95% CI, 1.03-1.84); Hypertensive disorders of pregnancy (RR, 1.55; 95% CI, 1.29-1.87); Gestational diabetes (RR, 1.61; 95% CI, 1.40-1.85); and Long-term risk for hospitalization (RR, 2.29; 95% CI, 2.07-2.55). 1 Among birth outcomes, an increased risk for preterm birth (RR, 1.28; 95% CI, 1.07-1.53) and cesarean delivery (RR, 1.18; 95% CI, 1.07-1.30) were noted among patients with HS. The children of mothers with HS had an increased risk for birth defects (RR, 1.29; 95% CI, 1.07-1.56) and long-term risk for childhood hospitalization (RR, 1.31; 95% CI, 1.18- 1.45). 1 The odds of a spontaneous abortion (14%), ectopic pregnancy (73.2%), therapeutic abortion (52.9%), and stillbirth (76.2%) compared with a live birth were significantly greater in patients with HS, according to analyses of a 2025 retrospective study. 2 Retrospective studies published in 2022 also observed heightened risks in many of these maternal and obstetric outcomes. 3,4 “However, a limitation of these studies is the lack of data regarding whether pregnancy outcomes may be influenced by HS disease severity or whether a patient’s HS disease is well-controlled,” noted Jennifer Hsiao, MD, clinical associate professor of dermatology and director of the Hidradenitis Suppurativa Specialty Clinic at Keck Medicine of the University of Southern California. https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 2 of 6Regarding HS outcomes, studies have demonstrated that while 24% of patients with HS reported symptom improvement during pregnancy, 20% reported worsening symptoms in pregnancy and 60% reported postpartum disease flares. 5 In a large French study published in 2025, a substantial number of women with HS indicated impairment in multiple areas of sexual functioning, and more than one- third reported that they had hesitated or decided not to have a child because of their HS. 7 Recommendations on HS Treatment During Pregnancy Several papers have discussed clinical insights and treatment considerations for patients with HS who are pregnant or breastfeeding. 5,7-9 While some therapies have adequate literature available to support their use in pregnant and breastfeeding patients, other typical HS therapies are contraindicated, and others still need further exploration. “It is important for women with HS to know that HS can still be treated while they are planning pregnancy and also when they are pregnant,” Dr Hsiao emphasized. “In addition, many patients with HS may automatically self-discontinue all medications when they find out they are pregnant,” Dr Hsiao added, which underscores the need for patient education and counseling on this topic prior to pregnancy. Managing HS in pregnancy requires consideration of potential risks to both the patient and the fetus. “Topical options, like prescription clindamycin lotion or benzoyl peroxide washes at low concentrations, are considered safe and are often used as first-line therapy,” said Marisa Garshick, MD, dermatologist at MDCS Dermatology: Medical Dermatology & Cosmetic Surgery and clinical assistant professor of dermatology at Weill Cornell Medicine. 9 “If systemic treatment is required, antibiotics such as clindamycin or cephalexin are generally preferred, but tetracyclines like doxycycline should be avoided,” Dr Garshick continued. https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 3 of 6Systemic retinoids and most hormonal therapies are also contraindicated during pregnancy due to fetal risks, Dr Adigun added. 9 “In terms of biologic therapy for HS during pregnancy, tumor necrosis factor-alpha antagonists have the most data supporting their safety, but there is increasing data for interleukin-17 inhibitors,” Dr Hsiao stated. 9 “ Contributing to pregnancy exposure registries will help improve our understanding regarding safety of biologics in pregnancy.” “There is also emerging evidence that using metformin is both safe and efficacious for HS during pregnancy,” Dr Adigun said. 9 “Procedures for HS flares, including intralesional steroid injections and incision and drainage of abscesses, may still be performed, though it is generally recommended to hold off on large HS excisions during pregnancy, if possible,” according to Dr Hsiao. 9 Dr Garshick highlighted the need for a multidisciplinary approach in the treatment of pregnant and postpartum patients, which should include collaboration with obstetricians and maternal-fetal medicine colleagues as needed. Additionally, “Optimizing comorbidities such as smoking cessation and glucose control can improve outcomes both for pregnancy and HS.” Dr Garshick further noted the importance of planning ahead with patients for safe, effective therapies after delivery and during breastfeeding, given the high prevalence of postpartum flares. A small survey-based study found that 83% of women with HS had not received guidance from their physician regarding the potential impact of HS and HS therapies on pregnancy outcomes. 10 “Open and ongoing conversations with patients about their goals for family planning and disease management are essential so that treatments may be adjusted if needed,” Dr Garshick advised. Remaining Gaps https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 4 of 6To improve outcomes in this patient population, additional research and education are warranted. Dr Hsiao pointed to the need for prospective studies that include data on HS disease course, severity, and treatment patterns during pregnancy, as well as the influence of these factors on maternal and neonatal outcomes in patients with HS. “There is definitely a gap in evidence regarding both safety and efficacy of new therapies for HS in pregnant and lactating women,” Dr Adigun said. “Given how common this condition is and the significant impact it has on pregnancy and neonatal outcomes, there is a need for further research and investigation.” “ One of the biggest challenges is the limited data on how to best manage HS during pregnancy,” according to Dr Garshick. She also cited the need for increased education of both patients and providers and greater collaboration between clinicians. “Education is key, as many patients and even some providers may not be aware of how HS can impact pregnancy outcomes, so increasing awareness could help with earlier intervention and better counseling,” Dr Garshick said. “Ultimately, more collaboration between dermatology, obstetricians, and primary care clinicians would help ensure patients receive comprehensive care throughout pregnancy and beyond.” References: 1. 2. 3. Li K, Piguet V, Croitoru D, et al. Hidradenitis suppurativa and maternal and offspring outcomes. JAMA Dermatol . 2024;160(12):1297-1303. doi:10.1001/jamadermatol.2024.3584 Walsh DP. Pregnancy outcomes in hidradenitis suppurativa patients. AMIA Annu Symp Proc . 2025;2024:1169-1175. PMID:40417565 Fitzpatrick L, Hsiao J, Tannenbaum R, Strunk A, Garg A. Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa. J Am Acad Dermatol . 2022;86(1):46-54. doi:10.1016/j.jaad.2021.06.023 https://www.dermatologyadvisor.com/features/hidradenitis-supp903a4297c649084&hmsubid=&nid=2049200711&elqtrack=True 28/5/26, 8:16 AM Page 5 of 64. 5. 6. 7. 8. 9. 10. Sakya SM, Hallan DR, Maczuga SA, Kirby JS. Outcomes of pregnancy and childbirth in women with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86(1):61-67. doi:10.1016/j.jaad.2021.05.059 Seivright JR, Villa NM, Grogan T, et al. Impact of pregnancy on hidradenitis suppurativa disease course: a systematic review and meta-analysis. 2022;238(2):260-266. doi: 10.1159/000517283. Özbek L, Güldan M, Alpsoy E, Vural S. Hidradenitis suppurativa treatment during pregnancy and lactation: navigating challenges. Int J Dermatol. 2025;64(7):1173-1185. doi:10.1111/ijd.17672 Fite C, Taieb C, Nassif A, et al. High sexual impact of hidradenitis suppurativa in women with more than one-third of patients renouncing a desire for pregnancy: Results of a nationwide study in France. Clin Exp Dermatol. 2025;50(8):1647-1649. doi:10.1093/ced/llaf116 Chung CS, Park SE, Hsiao JL, Lee KH. A review of hidradenitis suppurativa in special populations: Considerations in children, pregnant and breastfeeding women, and the elderly. Dermatol Ther (Heidelb) . 2024;14(9):2407-2425. doi:10.1007/s13555-024-01249-2 Ghanshani R, Lee K, Crew AB, Shi VY, Hsiao JL. A guide to the management of hidradenitis suppurativa in pregnancy and lactation. Am J Clin Dermatol. 2025;26(3):345-360. doi:10.1007/s40257-025-00935-x Adelekun AA, Villa NM, Hsiao JL, Micheletti RG. Pregnancy in hidradenitis suppurativa – patient perspectives and practice gaps. JAMA Dermatol. 2021;157(2):227-229. doi:10.1001/jamadermatol.2020.5162 Sent from my iPhone Benjamin Hidalgo-Matlock Skin Care Physicians of Costa Rica Clinica Victoria en San Pedro: 4000-1054 Momentum Escazu: 2101-9574 Please excuse the shortness of this message, as it has been sent from a mobile device.

Finasteride dosis baja y disfunción eréctil... nueva data.

May 19, 2026

Low-dose finasteride linked to higher erectile dysfunction risk over time

WASHINGTON, DC -- May 19, 2026 -- A large retrospective study of more than 10,000 men with androgenetic alopecia found that low-dose finasteride (1 mg) was associated with a significantly increased risk of new-onset erectile dysfunction at both 1 year and 3 years compared with matched controls not taking the drug.

The findings, presented at the 2026 Annual Meeting of the American Urological Association (AUA), highlight the need for clinicians to discuss potential long-term sexual side effects with younger patients considering finasteride therapy and reinforce the importance of shared decision-making in hair loss treatment.

“Finasteride remains an effective, FDA-approved treatment, and for many men, the benefit to their hair and to their confidence will outweigh the risk that we observed,” reported Hriday Bhambhvani, Weill Cornell Medicine, New York, New York.

For the study, the researchers evaluated data from the TriNetX Research Network, identifying men aged 18 and 45 years with androgenetic alopecia and no prior history of erectile dysfunction. Using propensity score matching, 5,091 men who were prescribed 1 mg finasteride were compared with 5,091 controls, balancing groups for age, body mass index, race and ethnicity, depression, anxiety, tobacco use, alcohol use, hypertension, hyperlipidaemia, type 2 diabetes, and sleep apnoea.

For the primary outcome, no significant differences were observed between the 2 groups in terms of new-onset erectile dysfunction at 6 months (risk ratio [RR], 1.32; P = .21).

However, a significantly higher incidence of erectile dysfunction was observed with the finasteride group at 1 year (1.61% vs 0.96%; RR, 1.67; P = .004) and at 3 years (3.73% vs 2.36%; RR, 1.58; P = .0001).

“As we looked further out, a significant gap emerged at 3 years and those on finasteride had a meaningfully higher rate of erectile dysfunction, at about 4% compared to roughly 2.8% in the control group,” Bhambhvani said. “That corresponds to about a 46% higher risk. We also found significantly higher rates of low libido and ejaculatory dysfunction at the 3-year mark in the finasteride group.”

A further sensitivity analysis of the finasteride cohort compared with a separate propensity-matched cohort of men prescribed oral minoxidil 2.5 mg also similarly showed an increased 3-year risk for PDE5i prescription (4.03% vs 1.84%; RR, 2.19; P = .007). However, no difference in erectile dysfunction rates were observed at the 6-month and 1-year timepoints in the sensitivity analysis.

“The absolute difference in erectile dysfunction at three years was about 1.3%,” said Bhambhvani. “That means approximately 1 in 79 men on finasteride will develop erectile dysfunction as a result of the medication. Ultimately, the core message here is that shared decision-making providers should be having this conversation up front, laying out the real but modest risks discussing alternatives and letting the patient weigh in.”

“It's also worth noting that our study was not designed to assess whether these side effects persist after stopping finasteride,” he added. “That remains an important question for future research.”

[Presentation title: Risk of Erectile Dysfunction Among Reproductive-Aged Men Following Low-Dose Finasteride Use for Androgenetic Alopecia: A Propensity-Matched Cohort Study]

Prithviraj Bose, MD

EBAC® CE