Does it work? Laser therapy for Hidradenitis Suppurativa

Original Article: A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa

What are the key takeaways of this article?

Hidradenitis Suppurativa (HS), also known as acne inversa, is a chronic inflammatory disease characterized by painful and foul-smelling cystic nodules and sinus tracts in the apocrine gland-bearing regions; typically the axilla, groin, and perineum. As described from HS source, the Hurley staging system categorizes largely on the presence and extent of lesions, scarring, and sinus tracts. Hurley stage I is characterized by individual primary lesions and/or cysts without scarring or fistulae. Hurley stage II is characterized by individual primary lesions and/or cysts with scarring or fistulae. Finally, Hurley stage III, the most severe stage, is characterized as confluent primary and secondary lesions at the involved surface with fistulae and scars. Treatment options for HS range from topical, intralesional, and systemic therapies to surgical interventions; which include ​​antibiotics (often the first-line conservative treatment including clindamycin and rifampin), corticosteroids, immunomodulators such as adalimumab, retinoids, hormone therapy, and laser therapy. The only curative option for stage III disease is wide local excision with a skin flap, an approach which comes with risks for postoperative complications.

From the limited data available, laser therapy has shown promising effects including clinical improvement and extended disease-free periods for patients with a favorable side effect profile. Fortoul et al. conducted a retrospective review to evaluate the efficacy of laser therapy as a treatment modality for patients with HS. The authors analyzed data from 94 patients with HS undergoing laser treatment between 2016 and 2021 at the Atlantic Center of Aesthetic and Reconstructive Surgery in Fort Lauderdale, Florida, USA. Nd:YAG laser therapy was administered to all patients with an interval of at least 6 weeks between each laser session.

The average number of treatments received was 5.6 for a median treatment length of 16.5 months.

The majority of patients were classified as Hurley stage II (94.7%), followed by early stage III (10.5%), and early stage I (7.4%). All patients received Nd:YAG (1064 nm) laser therapy, with 49% receiving Nd:YAG exclusively. Adjunctive therapies included Botox injections for hyperhidrosis (13%), silver nitrate cauterization for patients with open or draining wounds (29%), and concomitant alexandrite laser (3%). The sample predominantly comprised females (87.2%), with a mean age of diagnosis of 16.2 ± 3.1 years. In terms of race, African-Americans constituted the majority at 51.6%, followed by White participants at 38.9%.

Nd:YAG laser showed improvement in all patients in the study without severe side effects, with the largest benefit occuring for patients with Hurley stage II disease. The patients continued with sessions until disease resolution, with 52% completing treatment, 16% with ongoing treatment at the end of the study and 31% of participants being lost to follow up. Other benefits of the Nd:YAG laser therapy includes localized treatment, minimal side effects and possible decrease in antibiotic use and associated antibiotic resistance. The authors also highlight the need and benefits of early diagnosis with one prior study reporting a 7 year delay in diagnosis of HS in contrast with the 1.2 year delay at the institution which likely contributed to the majority of participants with stage II disease. In summary, this study concluded that laser therapy is a promising treatment modality compared to other treatment options, given that lesion improvement occurred in all patients with no severe complications reported.

Publication Date: March 17th, 2024

Reference: Fortoul, M. C., Macias Martinez, B., Ventura Rodriguez, D., Dallara, M., Stelnicki, E. J., & Kamel, G. (2023). A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa. Annals of Plastic Surgery, 91(6), 758–762. https://doi.org/10.1097/SAP.0000000000003690

Summary By: Jaycie Dalson