# Fractional Microneedling Radiofrequency for Hidradenitis Suppurativa: A Real‐World Retrospective Study Demonstrating Clinical Efficacy and Safety Across Diverse Anatomical Sites

## TL;DR

Fractional microneedling radiofrequency (FMR) shows promise as a safe and effective treatment for hidradenitis suppurativa, particularly in challenging anatomical areas.

## Contribution

This study provides real-world evidence of FMR's clinical efficacy and safety for hidradenitis suppurativa across diverse anatomical sites.

## Key findings

- 94.1% of patients showed clinical improvement after FMR treatment.
- 52.9% of patients achieved a ≥55% reduction in HS severity score.
- FMR was well tolerated, with pain being the main reason for discontinuation.

## Abstract

Hidradenitis suppurativa (HS) remains a therapeutically challenging disease despite expanding research and evolving systemic treatments. Energy‐based modalities, such as fractional microneedling radiofrequency (FMR), are being increasingly explored as novel treatment options.

To evaluate the real‐world efficacy and safety of Morpheus8‐based FMR treatment in patients with HS.

This retrospective analysis included 25 HS patients treated at a tertiary dermatology center. Seventeen patients who completed ≥ 2 FMR sessions were included in the efficacy analysis. Outcomes were assessed by the International Hidradenitis Suppurativa Severity Score System (IHS4) and IHS4‐55 (≥ 55% reduction). High‐frequency ultrasound (HFUS) was used in selected cases to assess treatment response and inflammatory changes.

Sixteen of the 17 patients (94.1%) evaluated for efficacy showed clinical improvement, and nine (52.9%) achieved an IHS4‐55 response. The mean IHS4 reduction was 4.6 ± 2.5. The highest response rates were observed in the face, chest, and gluteal regions, while groin and thigh showed the lowest. HFUS confirmed a reduction in inflammation. Treatment was generally well tolerated, with pain cited as the most common reason for discontinuation in 3 of 25 patients (12%).

FMR appears to be a safe and effective treatment option for patients with moderate‐to‐severe HS, including those with refractory disease and lesions in anatomically challenging areas. Clinical outcomes in our cohort were comparable to those reported for advanced systemic agents and other technology‐based interventions. These findings support FMR's potential role in personalized HS management ‐ either as a standalone intervention or in combination with systemic or procedural treatments.