Efficacy of Nd:YAG Laser for the Treatment of Hidradenitis Suppurativa

Keywords:laser, treatment,  Time:24-03-2016

Hidradenitis Suppurativa (HS) is a recurrent and chronic inflammatory disease which can be disfiguring to patients. Usually patients present with tender inflammatory abscesses of the flexures, including the axillary, infra- mammary, and inguinal areas. Scarring and tract formation are prominent features. Females seem to be more often affected than males. Patients are usually post pubertal.

The chronic and scarring nature of the disease often leads to significant impacts on the quality of life in these patients [1,2]. HS was first described by Velpeau, a French physician, in 1839. He was also the first to hypothesize that the di- sease was related to purulent inflammation of the sweat glands, later thought to be mainly inflammation of apocrine [2]. More recent data however, supports the theory of follicular occlusion as the predominant feature with apocrine involvement a secondary feature. Bacterial co- lonization is also likely a secondary event which may exacerbate disease. Other factors which may be associated, but not etiologic, include smoking and obesity [2].

The prevalence of HS is estimated at about 1% of the population, but unfortunately there are limited effective treatment options [3]. Furthermore, large-scale rando-  
mized controlled trials have not been extensively performed. Current treatment options include topical or systemic antibiotics, isotretinoin, dapsone, biological agents, and surgical interventions. Increasing interest in the use of biologics has led to several recent studies, albeit with only limited numbers of patients. Infliximab was shown to be effective in small studies; however, its use is limited by both adverse effects and cost.

Adalimumab, according to a recent review, has not shown consistent results supporting its use despite its growing popularity although it has been well tolerated with no serious side effects reported in any of the studies. Traditional surgical intervention has been excision of the affected areas with variable recurrence rates and high associated morbidity. Newer approaches include the CO2 and Nd:YAG lasers both with promising results [4].

A study performed by Tierney et al in HS patients with moderate disease showed a 65.3% improvement in severity of disease after 4 monthly treatments with Nd:YAG laser. They theorized that the hair follicle was the nidus for inflammation and that destruction of the follicle would lead to improvement. They were able to support this theory with histopathologic evidence that the laser worked through selective photothermolysis of the follicular unit with a reduction in inflammatory lesions [1].

Based on the success of this study and others like it recently in the literature, we decided to further explore the efficacy of the Nd:YAG laser in treatment of patients with HS. Our study was unique in that we recruited patients even with minimal disease as the Nd:YAG laser has a very high safety profile with essentially no risk to the patients; therefore, justifying its use in even minimal disease to prevent scarring and tract formation. Our goals were to treat patients with HS with Nd:YAG laser therapy once monthly for 3 consecutive months and reevaluate after one month, to compare the effectiveness on one side (treatment side) of the patient to the other side (control side), to assess treatment response using a visual analogue scale, to assess subject satisfaction with a subject questionnaire, and to photodocument treatment response at each visit.