Combined fractional carbon dioxide laser and long-pulsed neodymium : yttrium-aluminium-garnet (1064 nm) laser in treatment of hidradenitis suppurativa; a prospective randomized intra-individual controlled study

Abstract

Background: Multiple treatment modalities were introduced for treatment of hidradenitis suppurativa (HS) but mostly with unsatisfactory results.

Objective: In this prospective randomized right-left intra-individual controlled study, we studied the safety and efficacy of combined treatment with fractional CO₂ laser and long pulsed Nd : YAG (1064 nm) laser in treatment of HS.

Methods: Twenty adult patients with HS were randomized into this study. The patients were randomly allocated to receive four laser sessions with 2 weeks interval. Control side received long pulsed Nd : YAG laser (1064 nm) only, and the other side (combined treatment side) received combined fractional CO₂ laser and long pulsed Nd : YAG (1064 nm) laser. Patients were clinically and histopathologically evaluated 2 weeks post treatment. Recurrence was evaluated 3 months post treatment. Outcome was clinically evaluated by physician global assessment (PGA), 10-point visual analog scale for patient's satisfaction, and side effects.

Results: Statistically significant higher improvement and patient's satisfaction was observed in combined treatment side compared with control side (P = 0.011, 0.048 respectively). Absence of recurrence was achieved by 55% of sides receiving combined treatment and 35% of control sides.

Conclusions: Combination of fractional CO₂ laser and long pulsed Nd : YAG (1064 nm) laser in treatment of HS had higher improvement and patient's satisfaction together with lower recurrence compared with long pulsed Nd : YAG (1064 nm) laser alone. Better results could be achieved with low PGA, non-obese populations, and absence of surgeries for the lesions.