Lasers and Intense Pulsed Light Hidradenitis Suppurativa

A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa

PURPOSE

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful and foul-smelling cystic nodules and sinus tracts in the apocrine gland-bearing regions. The treatment options include topical, intralesional, systemic, and surgical modalities. Currently, the most novel therapy is laser therapy to provide localized treatment without systemic adverse effects. However, data regarding patient outcomes after laser treatment are limited because of the low prevalence of this disease. This study aimed to evaluate the efficacy of laser therapy as a treatment modality for patients with HS.

METHODS

A retrospective review cohort analysis of patients with HS undergoing laser treatment between 2016 and 2021 was conducted. Patient demographics, lesion location(s), Hurley stage, age of onset and diagnosis, treatment length, type, outcomes, and complications were analyzed.

RESULTS

Ninety-four patients met the inclusion criteria; on average, patients were treated with 5.8 laser sessions for 14.8 months with no complications and minor blood loss. Hidradenitis suppurativa progression commonly starts during puberty, with a median onset of 13.8 years and diagnosis of HS at 16.2 years. All patients (n = 94) showed an improvement in HS disease severity: 59.6% completed treatment, 12.0% are currently undergoing treatment, and 26.0% were lost to follow-up.

CONCLUSIONS

Laser therapy is an effective and safe therapy for HS leading to improved quality of life and should be considered in the treatment and management of HS.

Laser and intense pulsed light in the treatment of hidradenitis suppurativa

Treatment of hidradenitis suppurativa (HS) requires a combination of medical, surgical, and lifestyle interventions. Intense pulsed light (IPL) and lasers have been reported to be useful. The aim of this review is to find the evidence supporting IPL and laser treatment of HS and to provide guidance for the management of specific HS lesions. We searched PubMed and Web of Science for "laser" and "hidradenitis suppurativa" on April 6, 2022. Inclusion criteria were >10 patients, reported follow-up, English language, and human subjects with a diagnosis of HS. A total of 724 articles were screened, but only 17 studies qualified for inclusion (IPL (n = 4), Nd:YAG (n = 6), CO2 laser (n = 6), and intralesional treatment (n = 2). The majority of the studies had a low (n = 10) or moderate (n = 7) evidence level. Treatment effect was noticed in studies using IPL and Nd:YAG (hair reduction). CO2 laser was used for surgery with a success rate ranging from 70.7% to 96.7%. CO2 laser is useful for surgery of stationary HS lesions, but it is difficult to draw a conclusion on the use of IPL and Nd:YAG (hair reduction) as the studies were too heterogeneous to perform a meta-analysis.

Clinical Epidemiology and Management of Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1-1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18-40 years, obstetrician-gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.

Systematic Review of Complications and Recurrences After Surgical Interventions in Hidradenitis Suppurativa

BACKGROUND

The possible connection between hidradenitis suppurativa (HS) patients undergoing surgery and higher complications/recurrences has been implied, but inconsistent results reported.

OBJECTIVE

To assess the complication and recurrence rates for HS patients undergoing surgery and to evaluate whether known HS comorbidities and habits (smoking, obesity and diabetes) have an effect on the complication and recurrence rates.

MATERIALS AND METHODS

A systematic review was conducted by 2 reviewers. PubMed and Embase were searched using a predefined search string created in collaboration between the authors and a librarian on January 23, 2019.

RESULTS

Of the 271 references in the original search, 54 relevant articles were identified. This systematic review indicates an overall mean complication rate of 24% and a mean recurrence rate of 20.1% for HS patients undergoing surgery.

CONCLUSION

No significant association between the known surgical risk factors and surgical complications-or recurrence rates in this patient group was found. This review revealed a lack of quality and quantity data in studying the complications/recurrences. The heterogeneity of the studies created limitations, and the presented mean complication/recurrence rates should be interpreted with the consequences thereof. It elucidates the need for better studies and a necessity for a standardized definition of postsurgical HS recurrence.

Hidradenitis suppurativa

Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. The estimated prevalence of HS is ~1% in most studied countries. Typically starting in early adulthood, cutaneous inflamed nodules, abscesses and pus-discharging tunnels develop in axillary, inguinal, gluteal and perianal body sites. The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1β and IL-17. The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients' quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.

Combined treatment of hidradenitis suppurativa with intense pulsed light (IPL) and radiofrequency (RF)

BACKGROUND

Hidradenitis suppurativa is a chronic inflammatory disease with high burden. Treatment options are often unsatisfactory. We assessed the effect of a combination therapy of intense pulsed light (IPL) and radiofrequency (RF).

METHODS

The explorative study included 47 patients and was performed as a prospective, monocentric, randomized, three-arm parallel-group design trial with a prior 12 weeks observation period. Treatment arms were IPL and RF monotherapies or IPL + RF combination therapy. After 12 weeks, all patients received IPL + RF for additional 12 weeks (cross-over). Primary endpoint was the change in active lesion numbers, secondary endpoint the change in Dermatology Quality of Life Index (DLQI).

RESULTS

After 12 weeks, active lesion counts of the IPL + RF group decreased more than in the IPL group (p = .044); the decrease in DLQI was significantly higher in the IPL + RF and RF groups compared to IPL. Prolonged 24-week treatment with IPL + RF obtained better results as 12 weeks. Overall, disease burden after 24 weeks of treatment compared to disease fluctuation during the observation period was significantly lower (change in active lesions -3.6, p = .001; in DLQI -5.2, p = .003).

CONCLUSIONS

IPL + RF treatment appears to represent a promising therapeutic option that leads to reduction of disease activity without severe side effects.

Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology

Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.

Hidradenitis Suppurativa (Hurley I/II): Serial Excisions with Primary Wound Closure Under Local Anesthesia As Most Adequate Treatment Approach

BACKGROUND

Acne inversa as a chronic inflammatory disorder can be divided into three stages according to Hurley's classification. It affects the axillary and anogenital region predominantly, and its chronic course of development is associated with a major negative impact on quality of life, especially in young patients. We discuss the different types of treatment in patients with acne inversa and the benefits of two-stage surgical treatment by serial excisions with primary wound closure under local anaesthesia.

CASE REPORT

We present a 28-year-old man with hidradenitis suppurativa stage I in the right axillary region and also in the pubic area. The patient is an active smoker. The patient was treated with Rifampicin 2x 300mg / day without any particular effect and preoperatively, systemic therapy with Clindamycin 4x 600mg / day was performed, combined with daily dressings with jodasept ointment for 7 days. The patient was treated through two surgical sessions under local anaesthesia with elliptical excision of the lesions located in the right axillary and the pubic area. Both of the two surgical defects were initially closed with single interrupted sutures. Histological examination of both lesions revealed the presence of suppurative folliculitis.

CONCLUSION

The literature describes various methods for treating acne inversa which include both systemic and local approaches. However, it is considered that drug therapy achieves only a temporary improvement in patients with hidradenitis suppurativa. For this reason, the surgical treatment of acne inversa is indicated as the only curative treatment, especially for recurrent lesions and serial excisions under local anaesthesia, followed by primary wound closure is a valuable treatment for patients with mild to moderate HS (Hurly stage I & II).