Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser

Hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory, scarring condition involving the intertriginous skin of the axillary, inguinal, inframammary, genital, and perineal areas of the body. It is also referred to as acne inversa and Verneuil disease. Follicular occlusion is the primary event in HS. It is now accepted that the first pathogenetic change is in the pilosebaceous follicular ducts, like acne, and so there has been a move to rename this disorder acne inversa. Despite the legitimate argument that hidradenitis suppurativa is a misnomer, the term has become generally accepted.

Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, often refractory to treatment. Patients with HS and dermatologists are in need of an effective, fast surgical intervention technique. Deroofing is a tissue-saving technique, whereby the "roof" of an abscess, cyst, or sinus tract is electrosurgically removed. The use of a probe is mandatory to explore the full extent of a lesion.

OBJECTIVE

We sought to evaluate the efficacy and patient satisfaction of the deroofing technique for recurrent Hurley I (mild) or II (moderate) graded HS lesions at fixed locations.

METHODS

An open study consisted of 88 deroofed lesions in 44 consecutive patients with HS, treated by a single clinician with a follow-up time of up to 5 years.

RESULTS

Fifteen of 88 (17%) treated lesions showed a recurrence after a median of 4.6 months. In all, 73 treated lesions (83%) did not show a recurrence after a median follow-up of 34 months. The median patient satisfaction with the procedure rated 8 on a scale from 0 to 10. Of the treated patients, 90% would recommend the deroofing technique to other patients with HS. One side effect occurred in the form of postoperative bleeding.

LIMITATIONS

Some patients were lost to follow-up.

CONCLUSIONS

The deroofing technique is an effective, simple, minimally invasive, tissue-saving surgical intervention for the treatment of mild to moderate HS lesions at fixed locations and it is suitable as an office procedure.

Effects of ablative 10,600-nm carbon dioxide fractional laser therapy on suppurative diseases of the skin: a case series of 12 patients

BACKGROUND AND OBJECTIVES

We have used an ablative 10,600-nm carbon dioxide fractional laser system (CO(2) FS) for suppurative diseases in order to attempt improvement. The purpose of our study was to demonstrate the effect of CO(2) FS on the course of inflammatory reactions in suppurative diseases.

MATERIALS AND METHODS

We reviewed a total of 12 Korean patients with suppurative diseases of the skin who had a history of treatment failure with several therapeutic modalities as well as active and multiple inflammatory lesions at the time of CO(2) FS treatment.

RESULTS

Improvement scores considering the number of suppurative lesions revealed that 3 of the 12 patients demonstrated clinical improvement of grade 4. Seven had clinical improvement of grade 3 and two showed improvement of grade 2. Improvement scores in severity were also evaluated; 2 of the 12 patients showed clinical improvement of grade 4. Six demonstrated clinical improvement of grade 3 and four had clinical improvement of grade 2. No patient showed a worsening of suppurative lesions.

CONCLUSION

Our observations demonstrated that the use of CO(2) FS did not make active suppurative lesions worse, and might have a therapeutic effect on suppurative diseases and their related scars. Lasers Surg. Med. 41:550-554, 2009. (c) 2009 Wiley-Liss, Inc.