Histopathologic Study of Hidradenitis Suppurativa Following Long-Pulsed 1064-nm Nd:YAG Laser Treatment

Abstract

To assess clinical and histopathologic changes occurring after long-pulsed 1064-nm Nd:YAG laser treatment of hidradenitis suppurativa (HS). Design: Prospective, controlled clinical and histologic study of patients with Hurley stage II HS disease.

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

“…The long-pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is a device that has traditionally been used for hair removal, but has recently shown promise in clearing old lesions of HS and preventing new eruptions. In accordance with studies in the current literature, we hypothesize that the Nd:YAG laser will significantly improve subjects with hidradenitis suppurativa compared to standard, uninvasive treatment with topical antibiotics [1,2]. Study aims include: to treat subjects with hidradenitis suppurativa with Nd:YAG laser therapy once monthly for 3 consecutive months, with a one month followup; to compare the effectiveness of Nd:YAG treatment on one side of the subject (e.g., right) to treatment with topical antibiotics on the subject's other side (e.g., left); to assess treatment response using a visual analogue scale; to assess subject satisfaction with treatment using a questionnaire; and to photodocument treatment response at each visit.…”

Laser and light-based treatments of hidradenitis suppurativa

“…Xu et al conducted a study assessing the clinical and histopathologic changes at different time points over 2 monthly sessions, with a 2-month follow-up thereafter, on 19 patients using the long-pulsed Nd:YAG laser. There was a 31.6% improvement in the laser-treated areas over all anatomic sites using the modified HS-LASI scoring system [31]. There was increased inflammation 1 week after treatment, followed by decreased inflammation, fibrosis and scarring at 1 and 2 months post-treatment with the laser.…”

“…Some patients reported increased tenderness and drainage 1 week after treatment, followed by rapid disease improvement, similar to the incision and drainage procedure. The Nd:YAG laser showed destruction of organized inflammatory lesions in the superficial to mid-dermis [31]. In all of the three studies using Nd:YAG for HS, single pass was performed on the affected region, and pulse stacking was performed two to three times on inflamed nodules, abscesses and fistulae [29][30][31].…”

“…Significant decrease in disease activity with healing of several lesions was noted after treatment, with no additional systemic or topical treatment at a follow-up of 6 months [39]. [31] ALA: Aminolevulinic acid; ALA-PDT: Aminolevulinic acid-photodynamic therapy; DCD: Dynamic cooling device; Nd:YAG: Neodymium:yttrium aluminum garnet; RCT: Randomized controlled trial; SPT: Skin phototype. given on the fluence and the outcome measures used [40] ALA: Aminolevulinic acid; ALA-PDT: Aminolevulinic acid-photodynamic therapy; DCD: Dynamic cooling device; Nd:YAG: Neodymium:yttrium aluminum garnet; RCT: Randomized controlled trial; SPT: Skin phototype.…”

Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

“…1 Reported improvement rates range from 31.6% to 72.7%. 128,129 Intense pulse light (IPL) used in a prospective trial of 18 patients, showed a 55% reduction of the Sartorius score compared to 10% on the untreated side. 130 Photodynamic therapy (PDT), reported in more than 20 HS patients, 1 has been described to have good to mediocre efficacy.…”