Laser May Be Better for Hidradenitis Suppurativa

KISSIMMEE, FLA. — The 1,064-nm neodymium:YAG laser is effective for treating and preventing the recurrence of hidradenitis suppurativa lesions, according to the results of a randomized, controlled study of 22 patients with the disease.

The 1,064-nm Nd:YAG laser is commonly used for laser hair removal but also seems well suited for treating hidradenitis suppurativa, which histologic studies suggest is a disease of follicular occlusion with apocrine gland involvement as a secondary event, according to Dr. Emily P. Tierney and her colleagues in the department of dermatology at Henry Ford Hospital, Detroit.

Despite the fact that medical treatments for hidradenitis suppurativa have had limited efficacy against the disease and surgical treatment is associated with high morbidity, an initial pilot study conducted by Dr. Tierney and her associates found the laser to be efficacious in treating the disease.

One of Dr. Tierney's coinvestigators in Henry Ford's dermatology department, Dr. Iltefat Hamzavi, previously conducted a study of the Nd:YAG laser in four patients with dissecting cellulitis, a disorder analogous to hidradenitis suppurativa. In that study, 1 year after the initiation of laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation (Dermatol. Surg. 2006;32:1039–44).

In a poster presentation at the annual meeting of the American Society for Laser Medicine and Surgery, Dr. Tierney and her coinvestigators reported on the effect of the laser on 22 patients with bilateral and symmetrical disease who were randomized to receive laser treatment plus topical antibiotics at affected sites on one side of the body and only topical antibiotics on affected sites on the contralateral side.

The patients had a mean age of 41 years, and 15 of them had Hurley stage II hidradenitis suppurativa, which is characterized by recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. The other seven patients had stage III disease, which is exemplified by diffuse or near diffuse involvement, or multiple interconnected tracts and abscesses across the entire area.

Half of the 22 patients had Fitzpatrick skin type III, followed by 4 patients with type V, 3 with type IV, 3 with type II, and 1 with type VI.

After a series of up to four laser treatment sessions conducted once per month, there was a significant improvement in clinical scoring criteria based on a modified Hidradenitis Suppurativa European Research Group (HISERG) scale at all three anatomical sites treated with the laser (groin, axilla, and inframammary sites).

Compared with control sites, laser treatment improved the modified HISERG scale by the greatest amount for inguinal lesions (68% vs. 2%). Laser treatment also significantly improved HISERG scale scores of lesions in the axilla (63% vs. −11%) and at inframammary sites (30% vs. −71%).

Dr. Tierney reported that their research was supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery and the Shahani Fund, a private individual donor that supports research at Henry Ford Hospital. Neither Dr. Tierney nor Dr. Hamzavi had any conflicts of interest to disclose.

At 2 months after the end of treatment, the patients continued to have significantly better modified HISERG scale scores at all sites combined, compared with all control sites combined.

The differences in response to laser treatment among anatomical sites appeared to be driven by the properties and distribution of hair at the site (density, volume, thickness, and proportion of follicles in anagen phase), according to the investigators.

The inguinal lesions of a patient with a 15-year history of disease are shown.

Lesion improvement is seen 2 months after four monthly laser treatments. Photos courtesy Dr. Emily P. Tierney

KISSIMMEE, FLA. — The 1,064-nm neodymium:YAG laser is effective for treating and preventing the recurrence of hidradenitis suppurativa lesions, according to the results of a randomized, controlled study of 22 patients with the disease.

The 1,064-nm Nd:YAG laser is commonly used for laser hair removal but also seems well suited for treating hidradenitis suppurativa, which histologic studies suggest is a disease of follicular occlusion with apocrine gland involvement as a secondary event, according to Dr. Emily P. Tierney and her colleagues in the department of dermatology at Henry Ford Hospital, Detroit.

Despite the fact that medical treatments for hidradenitis suppurativa have had limited efficacy against the disease and surgical treatment is associated with high morbidity, an initial pilot study conducted by Dr. Tierney and her associates found the laser to be efficacious in treating the disease.

One of Dr. Tierney's coinvestigators in Henry Ford's dermatology department, Dr. Iltefat Hamzavi, previously conducted a study of the Nd:YAG laser in four patients with dissecting cellulitis, a disorder analogous to hidradenitis suppurativa. In that study, 1 year after the initiation of laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation (Dermatol. Surg. 2006;32:1039–44).

In a poster presentation at the annual meeting of the American Society for Laser Medicine and Surgery, Dr. Tierney and her coinvestigators reported on the effect of the laser on 22 patients with bilateral and symmetrical disease who were randomized to receive laser treatment plus topical antibiotics at affected sites on one side of the body and only topical antibiotics on affected sites on the contralateral side.

The patients had a mean age of 41 years, and 15 of them had Hurley stage II hidradenitis suppurativa, which is characterized by recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. The other seven patients had stage III disease, which is exemplified by diffuse or near diffuse involvement, or multiple interconnected tracts and abscesses across the entire area.

Half of the 22 patients had Fitzpatrick skin type III, followed by 4 patients with type V, 3 with type IV, 3 with type II, and 1 with type VI.

After a series of up to four laser treatment sessions conducted once per month, there was a significant improvement in clinical scoring criteria based on a modified Hidradenitis Suppurativa European Research Group (HISERG) scale at all three anatomical sites treated with the laser (groin, axilla, and inframammary sites).

Compared with control sites, laser treatment improved the modified HISERG scale by the greatest amount for inguinal lesions (68% vs. 2%). Laser treatment also significantly improved HISERG scale scores of lesions in the axilla (63% vs. −11%) and at inframammary sites (30% vs. −71%).

Dr. Tierney reported that their research was supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery and the Shahani Fund, a private individual donor that supports research at Henry Ford Hospital. Neither Dr. Tierney nor Dr. Hamzavi had any conflicts of interest to disclose.

At 2 months after the end of treatment, the patients continued to have significantly better modified HISERG scale scores at all sites combined, compared with all control sites combined.

The differences in response to laser treatment among anatomical sites appeared to be driven by the properties and distribution of hair at the site (density, volume, thickness, and proportion of follicles in anagen phase), according to the investigators.

The inguinal lesions of a patient with a 15-year history of disease are shown.

Lesion improvement is seen 2 months after four monthly laser treatments. Photos courtesy Dr. Emily P. Tierney

KISSIMMEE, FLA. — The 1,064-nm neodymium:YAG laser is effective for treating and preventing the recurrence of hidradenitis suppurativa lesions, according to the results of a randomized, controlled study of 22 patients with the disease.

The 1,064-nm Nd:YAG laser is commonly used for laser hair removal but also seems well suited for treating hidradenitis suppurativa, which histologic studies suggest is a disease of follicular occlusion with apocrine gland involvement as a secondary event, according to Dr. Emily P. Tierney and her colleagues in the department of dermatology at Henry Ford Hospital, Detroit.

Despite the fact that medical treatments for hidradenitis suppurativa have had limited efficacy against the disease and surgical treatment is associated with high morbidity, an initial pilot study conducted by Dr. Tierney and her associates found the laser to be efficacious in treating the disease.

One of Dr. Tierney's coinvestigators in Henry Ford's dermatology department, Dr. Iltefat Hamzavi, previously conducted a study of the Nd:YAG laser in four patients with dissecting cellulitis, a disorder analogous to hidradenitis suppurativa. In that study, 1 year after the initiation of laser treatment, patients achieved decreased pus formation, a reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation (Dermatol. Surg. 2006;32:1039–44).

In a poster presentation at the annual meeting of the American Society for Laser Medicine and Surgery, Dr. Tierney and her coinvestigators reported on the effect of the laser on 22 patients with bilateral and symmetrical disease who were randomized to receive laser treatment plus topical antibiotics at affected sites on one side of the body and only topical antibiotics on affected sites on the contralateral side.

The patients had a mean age of 41 years, and 15 of them had Hurley stage II hidradenitis suppurativa, which is characterized by recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. The other seven patients had stage III disease, which is exemplified by diffuse or near diffuse involvement, or multiple interconnected tracts and abscesses across the entire area.

Half of the 22 patients had Fitzpatrick skin type III, followed by 4 patients with type V, 3 with type IV, 3 with type II, and 1 with type VI.

After a series of up to four laser treatment sessions conducted once per month, there was a significant improvement in clinical scoring criteria based on a modified Hidradenitis Suppurativa European Research Group (HISERG) scale at all three anatomical sites treated with the laser (groin, axilla, and inframammary sites).

Compared with control sites, laser treatment improved the modified HISERG scale by the greatest amount for inguinal lesions (68% vs. 2%). Laser treatment also significantly improved HISERG scale scores of lesions in the axilla (63% vs. −11%) and at inframammary sites (30% vs. −71%).

Dr. Tierney reported that their research was supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery and the Shahani Fund, a private individual donor that supports research at Henry Ford Hospital. Neither Dr. Tierney nor Dr. Hamzavi had any conflicts of interest to disclose.

At 2 months after the end of treatment, the patients continued to have significantly better modified HISERG scale scores at all sites combined, compared with all control sites combined.

The differences in response to laser treatment among anatomical sites appeared to be driven by the properties and distribution of hair at the site (density, volume, thickness, and proportion of follicles in anagen phase), according to the investigators.

The inguinal lesions of a patient with a 15-year history of disease are shown.

Lesion improvement is seen 2 months after four monthly laser treatments. Photos courtesy Dr. Emily P. Tierney