Medical treatments for hidradenitis suppurativa can help control symptoms and avoid complications, including medications and surgery.
Levi et al (2016) detailed the use of fractional CO2 laser treatment for scar revision in hypertrophic scar (HS) patients. Their analysis demonstrated an improvement in both observer- and patient-rated POSAS scores with laser treatments of mature hypertrophic scars in donor and graft regions.
Improved Skin Appearance
Traditional treatments for hypertrophic scars (HS) included skin grafts and dermabrasion, both highly invasive processes with significant risks. Laser and light therapies have been studied as potential therapies for treating HS with promising results; such therapies include decreasing inflammation, dissolving hair follicles, targeting sebaceous glands, killing bacteria, debulking lesions through ablation, as well as debulking lesions through ablation. No previous study has examined combining several of these modalities to improve outcomes related to HS.
HS is characterized by chronic fistulating lesions in intertriginous areas that are surrounded by thickened and inflamed tissue, often leading to painful and embarrassing oozing and itching. Removing only affected scar tissue can dramatically improve both its appearance as well as any associated discomfort or itching associated with this disorder. Employing the CO2 laser’s selective ablation technique could significantly alleviate both pain and itching associated with this condition.
A recent study assessed several laser and light therapies used to treat hyperhidrosis (HS), including CO2 laser scar reduction therapy. Researchers observed significant improvements in terms of pliability, tightness and cosmetic improvement with using CO2 laser therapy for this purpose – as well as reductions in rates of recurrence of scars or nodules caused by using this laser for this purpose.
After treatments with IPL and CO2 laser, the authors of the study noted significant reductions in pruritus and tightness, in addition to mature hypertrophic scars. Furthermore, combined treatment showed more improvements on the POSAS scale than either modality alone due to Nd:YAG laser’s ability to dispel melanin and water chromophores from dark skin which improves treatment efficacy.
Although HS treatment has proven successful, most insurance companies do not reimburse it due to it being considered experimental. The HS Institute hopes this will change in due course as more studies demonstrate its benefits; until then, patients interested in trying this therapy for HS should work with their physician and insurance plan administrator to get it covered by insurance plans.
Reduced Inflammation
Fractional CO2 laser therapy has been demonstrated to effectively decrease inflammation in hypertrophic scars. One study followed 15 patients with thermal burn scars (11 with hypertrophic scars and 4 with keloidal scars), who received three sessions of fractional CO2 laser over six weeks for hypertrophic scar treatment and 4 sessions for keloidal scar treatment respectively; results demonstrated significant improvements both clinically and histopathologically, with hypertrophic scars showing textural improvements while keloidal scars demonstrated decreased thickness/density/thickness/thickness/density respectively.
Results of this research demonstrated that CO2 laser therapy could significantly improve both symptoms and aesthetic appearance of scars across all patients treated, lessening pain significantly while also leading to far fewer complications than its original form. It was even recommended by National Collaborating Centre for Cancer clinical practice guidelines on Melanoma when other treatments had failed (Monstrey et al 2015).
CO2 Laser Surgery can also be effective at treating fibrosis of the dermis. Fibrotic scars typically feature thickened collagen bundles and tightness in their texture that cause itching and tightness in the skin; CO2 laser treatment breaks them up quickly and significantly reduces these symptoms – softening, thinning and more flexible scars in just one session! Reduced fibrosis of dermis is key in healing processes as well as returning normal tissue texture back onto skin surfaces.
Fractional CO2 laser treatments may also prove effective against other forms of scars, including elephantiasis nostras verrucosa (ENV). One patient who sought relief through laser treatment for her symptomatic scars experienced significant improvement cosmetically and the ENV was completely eliminated (Robinson & colleagues, 2018).
Surgical treatment for hidradenitis suppurativa can be complex and challenging, requiring extensive experience to execute successfully. Carbon dioxide laser excision with secondary intention has proven successful at eliminating affected skin while also preventing disease recurrence (Burke & colleagues, 2001). Recurrence rates were low after carbon dioxide laser excision; patients reported being happy with their results (Burke & colleagues). According to Burke & colleagues (2001), complete lesion resection remains crucial in successfully treating HS.
Reduced Pain
Hydradenitis Suppurativa can severely diminish quality of life for those affected. Frequent and painful outbreaks of HS lesions – which can occur at any age – restrict daily activities and leave sufferers incapacitated, leading to physical, emotional, and even self-esteem damage that lasts long after symptoms have subsided. Its persistent nature makes treating and preventing it difficult. As a result, patients experience significant physical and psychological discomfort along with a loss of self-worth.
Studies have demonstrated the CO2 laser treatment is an effective means of decreasing recurrent lesions and improving quality of life, by decreasing inflammation and inhibiting new cell production, which ultimately results in less suppuration, scarring, and pain.
CO2 lasers can also help patients improve the appearance of hypertrophic scars by stimulating collagen production within their skin, leading to increased pliability, surface area reduction, and color loss. Treatment may also help decrease stiffness leading to restricted range of motion.
Other treatments for hidradenitis suppurativa may include surgery or medications; however, both of these options can be costly and usually don’t offer lasting relief – for instance surgical drainage can work temporarily before sores reappear again.
Hydrodenitis Suppurativa may become chronic for some people and difficult to treat with antibiotics alone. When this occurs, carbon dioxide laser therapy could provide relief by decreasing recurrences of symptoms while relieving pain and itching simultaneously.
Studies evaluating carbon dioxide laser excision as an effective therapy for hidradenitis suppurativa have determined its safety and effectiveness, garnering very positive patient satisfaction ratings for this approach.
CO2 laser treatment for hidradenitis suppurativa sores is an effective and noninvasive way to make them go away and keep coming back. Furthermore, it can improve scar appearance making them look less disturbing – all within a doctor’s office! Furthermore, its quicker than other approaches such as incision and drainage and requires far fewer visits from patients who require such procedures for healing purposes.
Less Recurrence
CO2 laser treatment holds great potential to significantly decrease recurrence of hypertrophic scars (HS) and improve quality of life for those living with this debilitating disease. Recently, an institutional review board-approved retrospective cohort study investigated its effects using an intensive pulsed light/fractional ablative CO2 laser combination approach on mature hypertrophic scars in HS patients; investigators observed that it fared much better compared with individual therapies alone in terms of both recurrence reduction and quality of life measures.
This study’s findings indicate that CO2 laser treatment for HS is an effective and durable option, according to researchers. They noted that CO2 laser excision produced lower rates of recurrence than conventional surgical excision and comparable with non-surgical procedures such as cryotherapy; smoking smokers experienced similar healing times, recurrence rates and post-treatment complications as those without diabetes; diabetic patients however experienced longer healing times than others.
CO2 laser treatment offers more than just reduced recurrence rates – it is also safe and effective at treating hidradenitis suppurativa. An IRB-approved prospective study examined the safety and effectiveness of carbon dioxide laser evaporation for managing chronic, recalcitrant hidradenitis suppurativa lesions; 34 patients suffering from Hurley stage II hidradenitis suppurativa underwent this form of excision; results demonstrated lower recurrence rates than after conventional surgical excision; furthermore patients reported increased quality of life after laser excision than traditional surgical excision;
CO2 laser treatment has proven itself an effective remedy for elephantiasis nostras verrucosa (ENV). Robinson and colleagues described its effective use in treating ENV in a 57-year old female patient diagnosed with biopsy-proven ENV that had lymphocutaneous fistula. She underwent three laser treatments over six months which saw both cosmetic and symptomatic improvement resulting from this therapy.
CO2 lasers may also offer potential benefits in terms of alleviating penile erythema. Salvatore and colleagues conducted a clinical trial using CO2 lasers to treat 50 postmenopausal women who were dissatisfied with their VVA. Investigators reported reduced erythema levels as well as improvements in VHIS scores related to sexual function, emotional well-being, and overall satisfaction after treatments were administered using this laser technology.
