Laser, light-based therapies show increased utility in hidradenitis suppurativa

A multimodal approach that includes not only topical and systemic therapies but also laser and light-based therapies is recommended for hidradenitis suppurativa, according to a recent review article.

“Laser and light-based treatment modalities have been used alone and in combination with other treatment modalities for the treatment of HS with varying rates of success,” Alexis B. Lyons, MD, of the department of dermatology at Henry Ford Hospital, and colleagues wrote. “Most of the information in support or against their use has come from small clinical trials or case series.”

With this in mind, the researchers undertook the review of laser and light-based treatment modalities for hidradenitis suppurativa (HS), which is generally marked by inflammatory nodules, abscesses and sinus tracts in intertriginous areas.

Laser and light-based options are gaining popularity because they may be associated with fewer adverse events than systemic therapies. While the mechanism of action of many of these therapies is not fully certain, they may decrease inflammation, destroy hair follicles, target sebaceous glands, kill bacteria and debulk lesions through ablation, according to the researchers.

Nd:YAG laser shows promising evidence, with at least one randomized controlled trial demonstrating benefit in this patient population. Nd:YAG “selectively targets hair shafts and follicles via absorption by the melanin and water chromophore,” according to the authors. This modality can be used alone or possibly with greater efficacy when used in combination with CO₂ lasers for refractory patients.

As for CO₂, this approach results in minimal removal of unaffected tissue, the researchers said, adding that CO₂ lasers may also improve wound healing and visualization of the operative field.

Another approach is diode lasers, which generate multiple wavelengths, thereby improving on traditional crystals and dyes that are used in other lasers. Although a growing body of evidence is emerging for this modality, further study is needed.

Alexandrite lasers damage the bulge stem cell and dermal papilla of hair follicles by targeting melanin. Case reports have shown efficacy of this approach, but further study is needed.

Other researchers have investigated intense pulsed light, which uses a “broad-spectrum pulsed light source to emit a wavelength that is absorbed by chromophores in the skin,” the researchers wrote. Data on this approach include one randomized trial and several cases series that show some benefit.

Regarding photodynamic therapy, the researchers suggested that 5-aminolevulinic acid and methyl aminolevulinate are the most commonly used photosensitizers. Future research should zero in on the optimal photosensitizer and light source for topical and intralesional PDT in HS.

As for other laser and light-based modalities in HS, not enough data are available on radiofrequency, while careful patient selection is strongly recommended for external beam radiation. In addition, microwave technology has failed to demonstrate efficacy.

“An individualized patient-centered multimodal approach using a combination of topical, medical, systemic, laser, light-based and surgical options for the management of HS should be utilized,” the researchers said. – by Rob Volansky

Disclosure s : Lyons reports she is an investigator for Lenicura and General Electric. Please see the study for all other authors’ relevant financial disclosures.