The Efficacy of Intense Pulsed Light and Laser Hair Removal in Hidradenitis Suppurativa Treatment

November 2024 | Volume 23 | Issue 11 | 926 | Copyright © November 2024


Published online October 30, 2024

doi:10.36849/JDD.8627

Amreen Kanwal MSa, Vincent Pecora a, Mina Farah a, Adam Friedman MD FAADa,b

aGeorge Washington University School of Medicine and Health Sciences, Washington, DC
bGeorge Washington University Medical Faculty Associates, Department of Dermatology, Washington, DC

Abstract
Background: Hidradenitis suppurativa (HS) is a multifactorial disease that presents with chronic cycles of inflammation, healing, and scarring and that elicits a profoundly negative impact on patient quality of life regarding self-image, fear of stigmatization, and social isolation. Patients commonly develop painful, odorous abscesses that evolve into draining sinus tracts and disfiguring scarring.
Objective: While systemic medications and surgical therapies are often effective in reducing active lesion activity and inflammation, these therapies sometimes only provide modest success in the prevention of future recurrences and disease progression, warranting adjunctive therapies such as laser and light-based therapies.1 Herein, this systematic review has been conducted to assess the current level of evidence supporting intense pulsed light (IPL) and laser treatment for HS, with a focus on a decrease in the number of lesions with associated HS flares.
Methods: GRADE assessments were performed using PubMed and Scopus. Of 428 studies identified, 10 studies (n= 235) evaluated IPL or laser hair removal treatment and their effectiveness in reducing HS flares.
Results: Significant reductions in the overall count of inflammatory lesions were observed in all studies, with percentages ranging from 50% to 75%, and in some cases, achieving complete resolution. However, durations of disease remission varied.
Conclusion: These results provide a moderate level of evidence supporting the effectiveness of IPL and laser hair removal as adjunctive therapy in the treatment of HS; however, further long-term studies are required to provide future guidance on the most effective treatment duration and intervals for sustaining disease clearance.

J Drugs Dermatol. 2024;23(11): doi:10.36849/JDD.8627

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic condition that presents with inflammatory lesions which commonly present at sites bearing apocrine glands. HS is a multifactorial disease, and factors such as genetics, existing inflammatory conditions, hormonal imbalances, and smoking all contribute to its pathogenesis.2,3 HS lesions are often deep seated and develop as nodules, abscesses, or draining sinus tracts. Severe progression of the disease may also lead to the formation of open comedones, disfiguring scarring, and fistulas.4 These lesions often reappear in areas where skin surfaces come in contact, such as the groin, axilla, perianal, and sub-mammary regions.5 The pathogenesis of HS is complex and nonlinear, involving follicular occlusion and an inappropriate and robust inflammatory response when the occlusion ruptures, leading to cycles of tissue destruction and scarring.2 The quality of life of patients with HS is greatly affected, demonstrated by patients with HS scoring low on a self-reported level of health status scales and taking a higher frequency of sick leave from work.6

Management strategies for HS have many limitations because there lacks a universally accepted treatment protocol, and it is often treated with a combination of modalities, including topical and systemic medications and surgical interventions.23 Laser hair removal has been used as a means for hair depilation. It works by selectively targeting melanin within hair follicles photothermally while sparing the surrounding tissue.7 Melanin within hair follicles absorbs wavelengths admitted by lasers, converts it to heat, and diffuses it to cause damage to the stem cells within the follicle.7 A variety of laser types are used in hair depilation and vary in range in the wavelengths they emit, with longer wavelengths causing fewer adverse effects and penetrating deeper melanin.7 The wavelength of the alexandrite laser is 755 nm, while the wavelength for the long-pulsed neodymium-doped yttrium aluminium garnet (Nd:YAG) laser is 1,1064 nm; and intense pulsed light (IPL) 590 nm to 1200 nm.7

While laser hair removal has long been used for cosmetic hair removal, its use in the treatment of dermatologic conditions