Energy-based device innovations including laser and non-laser therapies in hidradenitis suppurativa treatment

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is often difficult to treat. When initial medical treatments fail, surgical interventions, including laser and non-laser procedures, may be considered. This review examines recent studies investigating the effectiveness of these procedures, focusing on publications since March 2019. The review included English-language case reports, studies, and clinical trials sourced from PubMed using search terms such as "hidradenitis suppurativa," "Nd: YAG," "photodynamic therapy," "intense pulsed light," "alexandrite," "diode," "CO2," "radiofrequency," "ablative," "fractionated," "laser," and "hair removal." Review articles and animal studies were excluded. The review found strong evidence supporting the use of Nd: YAG and CO2 lasers for reducing inflammatory lesions and excising sinus tracts. Alexandrite lasers also showed promise, with 50% of treated patients achieving a Hidradenitis Suppurativa Clinical Response (HiSCR) at 15 weeks, increasing to 70% by week 30. Fractional radiofrequency (RF) microneedling and radiofrequency-intense pulsed light (RF-IPL) combinations led to reduced inflammation and improved tissue remodeling by weeks 6 and 24, respectively. Both intralesional and traditional photodynamic therapy (PDT) approaches demonstrated efficacy in reducing lesion size and associated symptoms. In conclusion, various laser and non-laser energy-based therapies show promise for managing HS, particularly in cases refractory to conventional treatments. Further research with robust study designs is warranted to optimize treatment protocols and establish long-term efficacy.