Light and Laser-based Treatments for Hidradenitis Suppurativa: A Systematic Review
Main Article Content
Keywords
hidradenitis suppurativa, UV Phototherapy, photodynamic therapy
Abstract
Background: Hidradenitis suppurativa (HS) is characterized by painful, recurrent lesions occurring mainly in intertriginous areas. The pain, odor, and disfigurement caused by HS significantly impacts quality of life and is challenging to treat. A comprehensive systematic review evaluating the use of light and laser-based treatments for HS is lacking.
Methods: We performed a systematic review by searching Cochrane, MEDLINE and Embase. Title, abstract and full text screening, and data abstraction were done in duplicate.
Results: Forty studies met the inclusion criteria, representing a total of 821 patients. Included studies were comprised of 5 randomized within-patient controlled trials, 1 randomized controlled trial, and 34 case series. Overall, treatments with the most reported cases were laser surgery, photodynamic therapy (PDT), and laser field treatments which showed a response in 80% (n=344/431), 73% (n=122/167) and 71% (n=84/101) of treated patients respectively. The pooled response rate for psoralen plus ultraviolet A was 69% (n=9/13).
Conclusion: Our results suggest that laser surgery using carbon dioxide (CO2) laser or a combination of CO2 and Nd:YAG lasers has a moderate response rate for HS with the most reported cases. Laser for field treatment and PDT also had moderate response rates with a large number of reported cases. However, extrapolation of these results may be limited due to the majority of the studies being case series, lack of standardized outcomes being assessed, and insufficient long term follow up results.
References
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2. Matusiak L, Szczech J, Bieniek A, Nowicka-Suszko D, Szepietowski JC. Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents. Journal of the American Academy of Dermatology. Apr 2017;76(4):670-675. doi:10.1016/j.jaad.2016.10.042
3. Wright S, Strunk A, Garg A. New Onset Depression among Children, Adolescents, and Adults with Hidradenitis Suppurativa. J Am Acad Dermatol. May 2020;doi:10.1016/j.jaad.2020.05.090
4. Alavi A, Anooshirvani N, Kim WB, Coutts P, Sibbald RG. Quality-of-life impairment in patients with hidradenitis suppurativa: a Canadian study. Am J Clin Dermatol. Feb 2015;16(1):61-5. doi:10.1007/s40257-014-0105-5
5. von der Werth JM, Jemec GB. Morbidity in patients with hidradenitis suppurativa. Br J Dermatol. Apr 2001;144(4):809-13. doi:10.1046/j.1365-2133.2001.04137.x
6. Saunte DM, Boer J, Stratigos A, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. Dec 2015;173(6):1546-9. doi:10.1111/bjd.14038
7. Shareef M, Dawe R. Bath psoralen plus ultraviolet A for hidradenitis suppurativa: a review of 13 patients. Br J Dermatol. Apr 2011;164(4):895-6. doi:10.1111/j.1365-2133.2010.10193.x
8. Suárez Valladares MJ, Eiris Salvado N, Rodríguez Prieto MA. Treatment of hidradenitis suppurativa with intralesional photodynamic therapy with 5-aminolevulinic acid and 630nm laser beam. J Dermatol Sci. Mar 2017;85(3):241-246. doi:10.1016/j.jdermsci.2016.12.014
9. Grimstad O, Tzellos T, Dufour DN, et al. Evaluation of medical and surgical treatments for hidradenitis suppurativa using real-life data from the Scandinavian registry (HISREG). Journal of the European Academy of Dermatology and Venereology. Jun 2019;33(6):1164-1171. doi:10.1111/jdv.15353
10. Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. Journal of the American Academy of Dermatology. Apr 2010;62(4):637-645. doi:10.1016/j.jaad.2009.07.048
11. Hamzavi IH, Griffith JL, Riyaz F, Hessam S, Bechara FG. Laser and light-based treatment options for hidradenitis suppurativa. J Am Acad Dermatol. Nov 2015;73(5 Suppl 1):S78-81. doi:10.1016/j.jaad.2015.07.050
12. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. Jul 2009;339:b2535. doi:10.1136/bmj.b2535
13. Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ. Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA. Dec 1995;274(22):1800-4. doi:10.1001/jama.274.22.1800
14. Abdel Azim AA, Salem RT, Abdelghani R. Combined fractional carbon dioxide laser and long-pulsed neodymium : yttrium-aluminium-garnet (1064 nm) laser in treatment of hidradenitis suppurativa; a prospective randomized intra-individual controlled study. International journal of dermatology. 2018;57(9):1135-1144. doi:https://dx.doi.org/10.1111/ijd.14075
15. Braunberger TL, Vakharia P, Nicholson CL, Parks-Miller A, Hamzavi IH. CARBON DIOXIDE LASER EXCISION IN HIDRADENITIS SUPPURATIVA: DEMOGRAPHICS, COMORBIDITIES, HEALING TIME AND COMPLICATIONS. Lasers in Surgery and Medicine. Apr 2018;50(4):360-360.
16. Crocco EI, Dalapicola MC, Suzuki NM, Alves RO. Surgical Treatment of Chronic Hidradenitis Suppurativa: CO2 Laser Stripping-Second Intention Technique. Dermatologic Surgery. Mar 2016;42(3):429-431. doi:10.1097/dss.0000000000000637
17. Dalrymple JC, Monaghan JM. TREATMENT OF HIDRADENITIS SUPPURATIVA WITH THE CARBON-DIOXIDE LASER. British Journal of Surgery. May 1987;74(5):420-420. doi:10.1002/bjs.1800740535
18. Fabbrocini G, França K, Lotti T, et al. Intralesional Diode Laser 1064 nm for the Treatment of Hidradenitis Suppurativa: A Report of Twenty Patients. Open Access Maced J Med Sci. Jan 2018;6(1):31-34. doi:10.3889/oamjms.2018.045
19. Finley EM, Ratz JL. Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing. Journal of the American Academy of Dermatology. Mar 1996;34(3):465-469. doi:10.1016/s0190-9622(96)90441-7
20. Grimstad Ø, Tzellos T, Dufour DN, et al. Evaluation of medical and surgical treatments for hidradenitis suppurativa using real-life data from the Scandinavian registry (HISREG). J Eur Acad Dermatol Venereol. Jun 2019;33(6):1164-1171. doi:10.1111/jdv.15353
21. Hazen PG, Hazen BP. Hidradenitis Suppurativa: Successful Treatment Using Carbon Dioxide Laser Excision and Marsupialization. Dermatologic Surgery. Feb 2010;36(2):208-213. doi:10.1111/j.1524-4725.2009.01427.x
22. Highton L, Chan WY, Khwaja N, Laitung JKG. Treatment of Hidradenitis Suppurativa with Intense Pulsed Light: A Prospective Study. Plastic and Reconstructive Surgery. Aug 2011;128(2):459-465. doi:10.1097/PRS.0b013e31821e6fb5
23. Jain V, Jain A. Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus. J Cutan Aesthet Surg. Jul 2012;5(3):190-2. doi:10.4103/0974-2077.101377
24. Lapins J, Marcusson JA, Emtestam L. SURGICAL-TREATMENT OF CHRONIC HIDRADENITIS SUPPURATIVA - CO2-LASER STRIPPING-SECONDARY INTENTION TECHNIQUE. British Journal of Dermatology. Oct 1994;131(4):551-556.
25. Lapins J, Sartorius K, Emtestam L. Scanner-assisted carbon dioxide laser surgery: a retrospective follow-up study of patients with hidradenitis suppurativa. J Am Acad Dermatol. Aug 2002;47(2):280-5. doi:10.1067/mjd.2002.124601
26. Madan V, Hindle E, Hussain W, August PJ. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. British Journal of Dermatology. Dec 2008;159(6):1309-1314. doi:10.1111/j.1365-2133.2008.08932.x
27. Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. Apr 2010;62(4):637-45. doi:10.1016/j.jaad.2009.07.048
28. Mikkelsen PR, Dufour DN, Zarchi K, Jemec GBE. Recurrence Rate and Patient Satisfaction of CO2 Laser Evaporation of Lesions in Patients With Hidradenitis Suppurativa: A Retrospective Study. Dermatologic Surgery. Feb 2015;41(2):255-260. doi:10.1097/dss.0000000000000264
29. Naouri M, Maruani A, Lagrange S, et al. Treatment of hidradenitis suppurativa using a long-pulsed hair removal neodymium:yttrium-aluminium-garnet laser: A multicenter, prospective, randomized, intraindividual, comparative trial. J Am Acad Dermatol. Jan 2021;84(1):203-205. doi:10.1016/j.jaad.2020.04.117
30. Piccolo D, Di Marcantonio D, Crisman G, et al. Unconventional use of intense pulsed light. Biomed Res Int. 2014;2014:618206. doi:10.1155/2014/618206
31. Riis PT, Saunte DM, Sigsgaard V, Wilken C, Jemec GBE. Intense pulsed light treatment for patients with hidradenitis suppurativa: beware treatment with resorcinol. Journal of Dermatological Treatment. 2018;29(4):385-387. doi:10.1080/09546634.2017.1387226
32. Vossen A, van der Zee HH, Terian M, van Doorn MBA, Prens EP. Laser hair removal alters the disease course in mild hidradenitis suppurativa. Journal Der Deutschen Dermatologischen Gesellschaft. Jul 2018;16(7):901-903. doi:10.1111/ddg.13563
33. Xu LSY, Wright DR, Mahmoud BH, Ozog DM, Mehregan DA, Hamzavi IH. Histopathologic Study of Hidradenitis Suppurativa Following Long-Pulsed 1064-nm Nd:YAG Laser Treatment. Archives of Dermatology. Jan 2011;147(1):21-28. doi:10.1001/archdermatol.2010.245
34. Esposito C, Del Conte F, Cerulo M, et al. Pediatric Endoscopic Hidradenitis Treatment: A New Minimally Invasive Treatment for Pediatric Patients with Hidradenitis Suppurativa. Journal of Laparoendoscopic & Advanced Surgical Techniques. Apr 2020;30(4):464-470. doi:10.1089/lap.2019.0614
35. Wilden S, Friis M, Tuettenberg A, et al. Combined treatment of hidradenitis suppurativa with intense pulsed light (IPL) and radiofrequency (RF). Journal of Dermatological Treatment. 2019;((Wilden, Friis, Tuettenberg, Staubach-Renz, Wegner, Grabbe, von Stebut) Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany(von Stebut) Department of Dermatology, Faculty of Medicine, University of Cologne)doi:http://dx.doi.org/10.1080/09546634.2019.1677842
36. Agut-Busquet E, Romani J, Gilaberte Y, Garcia-Malinis A, Ribera-Pibernat M, Luelmo J. Photodynamic therapy with intralesional methylene blue and a 635 nm light-emitting diode lamp in hidradenitis suppurativa: a retrospective follow-up study in 7 patients and a review of the literature. Photochemical & Photobiological Sciences. 2016;15(8):1020-1028. doi:10.1039/c6pp00082g
37. Navarrete RA, Nisis AH, Cares JP. Effectiveness of 5-Aminolevulinic Acid Photodynamic Therapy in the Treatment of Hidradenitis Suppurativa: A Report of 5 Cases. Actas Dermo-Sifiliograficas. Jul-Aug 2014;105(6):614-617. doi:10.1016/j.ad.2013.10.016
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Nov 5, 2021
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Mukovozov, I., Mirali, S., Khaslavsky, S., & Kalia, S. (2021). Light and Laser-based Treatments for Hidradenitis Suppurativa: A Systematic Review. SKIN The Journal of Cutaneous Medicine, 5(6), 601–620. https://doi.org/10.25251/skin.5.6.4
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In-Depth Reviews
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