This emits a long wavelength of light that can penetrate deep into affected areas of skin, targeting hair follicles to promote their removal and reduce their growth (Ranaweera, 2014).
Effects may persist two months after the fourth treatment (Zouboulis, et al., 2015).
It is an ablative treatment whereby the CO2 laser vaporizes and/or excises treated tissue (Zouboulis, et al., 2015). The surgeon stops treatment when unaffected tissue is reached.
CO2 laser causes heating and vaporization of water in the targeted skin that results in thermal cutting or destruction of tissue.
Light source interacts with photosensitizing chemicals to promote cell and bacterial death at affected areas (van Straalen, Schneider-Burrus, & Prens, 2018).
Treated lesions heal with minimal scarring (Lexicomp, 2018).
Studies on electrosurgery and CO2 laser present similar results; electrosurgery involved a small number of patients. Electrosurgery and radiofrequency are ablative treatments that use high-frequency electric currents and radio waves, respectively, to destroy abnormal skin cell growth (Lin, 2011; National Cancer Institute at the National Institutes of Health).
In external beam radiation, high-energy rays are used to destroy cells (American Cancer Society, July). Due to inconsistent results based mainly on case reports, it should only be considered in those with severe HS who failed to respond to other treatments or cannot undergo excision.
IPL causes thermal damage to hair follicles using high-energy light, and has antibacterial effects (Highton, Chan, Khwaja, & Laitung, 2011).
The diode laser reduces the number of hair follicles, sebaceous glands, and bacteria (Fabbrocini, et al., 2018).
Light emitted by Alexandrite lasers selectively target and damage the tissue of lesions while sparing surrounding healthy tissue, and can target hair follicles to promote hair removal (Ranaweer, 2014).
Fractionated CO2 laser delivers a beam divided into thousands of tiny treatment columns onto the skin surface. Within each treatment zone, surface and deeper skin cells are injured, resulting in stimulation of the skin repair process (Ngan, 2015). It has been reported to assist post-surgical scar contraction and wound healing.
Those with any Hurley stage (Hamzavi, Griffith, Riyaz, Hessam, & Bechara, 2015; Mahmoud, Tierney, Hexsel, Pui, Ozog, & Hamzavi, 2010; Tierney, Mahmoud, Hexsel, Ozog, & Hamzavi, 2009; Xu, Wright, Mahmoud, Ozog, Mehregan, & Hamzavi, 2011).
Those with recurrent lesions (Hamzavi, Griffith, Riyaz, Hessam, & Bechara, 2015), especially in the underarm and groin regions (Xu, Wright, Mahmoud, Ozog, Mehregan, & Hamzavi, 2011).
It has been found to be less effective in those with HS below the breast (Hamzavi, Griffith, Riyaz, Hessam, & Bechara, 2015).
It may prevent new lesions in those with sinus tract formation.
Those with Hurley stage II/III (Hamzavi, Griffith, Riyaz, Hessam, & Bechara, 2015). In particular, Hurley stage II/III patients with fibrotic sinus tracts.
Those with Hurley stage I/II (Hamzavi, Griffith, Riyaz, Hessam, & Bechara, 2015).
No absolute contraindications.
Affected underarm regions containing dark, coarse hair improved faster and greater than affected areas below the breast containing short, thin, light hair (Mahmoud, Tierney, Hexsel, Pui, Ozog, & Hamzavi, 2010).
No absolute contraindications.
Those with allergies to photosensitizing chemicals; those with diseases triggered by light exposure (Lexicomp, 2018).
Level of Evidence: Level II
Strength of recommendation: “B” rating
In 3 randomized trials totalling 63 Hurley stage II/III patients, improvement was greater on affected areas treated with Nd:YAG vs. those serving as controls after 4 monthly sessions (Mahmoud, Tierney, Hexsel, Pui, Ozog, & Hamzavi, 2010; Tierney, Mahmoud, Hexsel, Ozog, & Hamzavi, 2009; Xu, Wright, Mahmoud, Ozog, Mehregan, & Hamzavi, 2011).
Level of Evidence: Level II, III
Strength of recommendation: “C” rating
Satisfactory results were observed in 6 studies totalling 193 HS patients who received CO2 laser treatment (Mikkelsen, Dufour, Zarchi, & Jemec, 2015; Hazen & Hazen, 2010; Lapins, Marcusson, & Emtestam, 1994; Finley & Ratz, 1996; Madan, Hindle, Hussain, & August, 2008; Lapins, Sartorius, & Emtestam, 2002).
Possible lower recurrence rates following CO2 laser compared to surgical excision based on low-quality studies.
Level of Evidence: Level II, III
Strength of recommendation: “C” rating
Little to no improvement in 3 reports totalling 13 HS patients (Passeron, Khemis, & Ortonne, 2009; Strauss, Pollock, Stables, Goulden, & Cunliffe, 2005; Sotiriou, Apalla, Maliamani, & Ioannides, 2009).
A reduction in lesions was observed following randomized topical photodynamic therapy in 10 HS patients (Fadel & Tawfik, 2015).
Among 38 HS patients with any Hurley stage, 29 and 8 patients experienced no lesions/symptoms and persistence of lesions/symptoms, respectively, following intralesional photodynamic therapy. Recurrence occurred in 1 patient (Suárez-Valladares, Eiris Salvado, & Rodríguez Prieto, 2017).
Level of Evidence: Level III
Strength of recommendation: “C” rating
10 of 12 Hurley stage I/II patients and 26 of 30 lesions were cured within a few weeks following electrosurgery (Aksakal & Adişen, 2008).
Sustained significant improvement was observed in a male HS patient who underwent 3 radiofrequency treatments (Iwasaki, Marra, Fincher, & Moy, 2008).
Level of Evidence: Level III
Strength of recommendation: “C” rating
A female HS patient experienced normal disease fluctuation following radiotherapy treatments (Trombetta, Werts, & Parda, 2010).
38% and 40% of 231 HS patients who received radiotherapy experienced complete and partial improvement, respectively. Less than 1% had no response (Fröhlich, Baaske, & Glatzel, 2000).
Level of Evidence: Level III
Strength of recommendation: “C” rating
In 1 Hurley stage I patient and another Hurley stage 2 patient, inflammation and pain were reduced, and hair removal was achieved following 6 sessions of IPL (Piccolo, et al., 2014).
18 Hurley stage II/III patients were randomized to IPL treatment on affected areas, with the opposite untreated side acting as a control, twice weekly for 1 month. Significantly greater improvement was observed on treated areas (Highton, Chan, Khwaja, & Laitung, 2011).
Level of Evidence: Level III
Strength of recommendation: “C” rating
Regression of lesions and occasional worsening was observed in a female Hurley stage II patient who received 6 sessions of the diode laser every 3-4 months (Sehgal, Verma, Sawant, & Paul, 2011).
Partial improvement was achieved following 4 diode laser treatments in another female HS patient (Downs, 2004).
Level of Evidence: Level III
Strength of recommendation: “C” rating
Improvement in pain and discharge, as well as recurrence, was noted after one session of long-pulsed Alexandrite laser in a male patient with Hurley stage II. Further improvement after the next two sessions followed (Tsai, Wang, Lu, & Tsai, 2013).
Level of Evidence: Level III
Strength of recommendation: “C” rating
The raw areas of a female Hurley stage III patient completely healed after 4 sessions of fractionated CO2 laser excision over 5-6 weeks. At 16 months post-surgery, HS did not re-occur (Nicholson, Hamzavi, & Ozog, 2016).
Serious: Bacterial infection, although it is rare (Ranaweera, 2014).
Other: Inflammation, increased drainage, or pain at treated sites; low risk of changes in skin pigmentation and inflammation of hair follicles (Mahmoud, Tierney, Hexsel, Pui, Ozog, & Hamzavi, 2010).
Pregnancy risk according to the U.S Food & Drug Administration (FDA):
Serious: Infection (Zouboulis, et al., 2015), hypertrophic granulation tissue, elevated white blood cell levels (Hazen & Hazen, 2010).
Other: Scarring (Zouboulis, et al., 2015), fever, rash (Hazen & Hazen, 2010).
Pregnancy risk according to the U.S FDA:
Serious: Infection, pigmentation problems, allergic reaction, scarring (Lexicomp, 2018).
Other: Temporary memory loss, pain (Lexicomp, 2018).
Pregnancy risk according to the U.S FDA:
Resulting inflammation may lead to tissue thickening and scarring 1-2 months later (Hamzavi, Griffith, Riyaz, Hessam, & Bechara, 2015).
Although 3-4 sessions were performed in most studies, more may be required for long-term benefits.
Following treatment, wounds heal without sutures, and are covered with dressings. Dressings may need to be changed daily until wounds are completely healed (Zouboulis, et al., 2015), which may take weeks (Hazen & Hazen, 2010).
The procedure may last several hours and multiple treatments may be required (Ngan, Photodynamic therapy, 2003).
Tetracycline antibiotics and retinoids should be stopped before treatment, as a light-triggered reaction may occur during the procedure (Lexicomp, 2018).
Sun avoidance for 48 hours post-procedure is required, as treated areas are sensitive to light (Lexicomp, 2018).