Laser and Light Therapy Shows Potential in Treating Hidradenitis Suppurativa

A review in the Journal of the American Academy of Dermatology (JAAD) suggests that laser- and light-based therapies can be effective as adjunct therapy in the treatment of hidradenitis suppurativa (HS). Originally introduced to reduce the size of pores in acne treatment, laser- and light-based therapy is showing potential in other forms of dermatologic treatment.

HS is a chronic inflammatory disease of the skin that is characterized by the formation of comedones and subcutaneous nodules in apocrine gland—bearing areas. These nodules can develop into painful, deep dermal abscesses and chronic, draining sinus tracts. Earlier research has suggested that these lesions are thought to develop via follicular occlusion, leading to secondary bacterial entrapment and sebaceous and apocrine gland rupture.

Pharmacologic and surgical therapies for HS are effective treatment, but they provide only modest success in the prevention of future recurrences of the disease. Laser-and light-based therapies can reduce the frequency of painful flares by decreasing the number of hair follicles, sebaceous glands, and bacteria in affected areas, and by ablatively debulking chronic, problematic lesions.

The JAAD review looked at not just current safety and effectiveness data, but also the recommended lengths and strengths of laser- and light-based therapy--important factors in treatment effectiveness. Depending upon a patient's severity of disease, different energy-based approaches are recommended. According to the review authors, “The best results are seen when treatment is individualized, taking disease severity into consideration when selecting specific energy-based approaches.”

The review examined several different lengths and strengths of therapy. For example, a study of the 1064-nm Nd:YAG laser showed that it reduced HS disease severity by more than 65% after 3 monthly treatments, with inguinal and axillary areas responding better than inframammary areas.

Though there is strong theoretical support for use of photodynamic therapy (PDT) for treating HS, the review reveals that clinical evidence is thus far scant. Two small-population studies of PDT found no improvement after the treatment. But more recent studies with modifications did show some results in some patients. More research is needed on the wavelengths and types of lasers that might be most effective.

Stronger findings exist for CO₂ lasers as an alternative to “cold steel” surgery, in part because of minimal removal of unaffected surrounding tissue, improved wound healing, and hemostatic properties that offer better visualization of the operative site. “In general, patients who undergo CO₂ surgery report superior scores for pain, scarring, and overall satisfaction compared to those undergoing traditional surgery,” the reviewers observed.

The study authors note that the promise of laser- and light-based therapy must be looked at in the context of a lack of comparative studies that show superiority over traditional excisional surgery.