The benefits and risks for those with HS

Hidradenitis suppurativa (HS) is an inflammatory skin condition that can cause lumps to form under the skin. Laser- and light-based therapies are becoming more and more common as a treatment option for HS.

HS can be painful and worsen over time. Treatments, which range from antibiotics to surgery, may be effective at reducing inflammation and lesion activity. However, they are only partially successful in preventing future recurrences and slowing the progression of the condition.

This article will explore laser hair removal, its benefits and risks, and how it might be helpful for people with HS.

HS is a condition where lumps form deep under the skin and can become painful. HS begins with hair follicles that are blocked with dead skin cells and oil, and it usually occurs in the armpits or groin.

As the condition progresses, bacteria begin to grow in the follicles, which leads to the swelling, pus, and odors typical of HS. Over time, the condition can worsen and cause tunnels beneath the skin, and permanent scars.

There are three clinical stages of HS:

  • Hurley stage 1: Itching or discomfort may precede the condition’s more obvious symptoms.
  • Hurley stage 2: Abscesses and scars form. There may be multiple lesions or just one. Tracts or tunnels beneath the skin may form as well.
  • Hurley stage 3: This is the most severe form. Widespread interconnected tracts and abscesses can occur across the entire affected area.

While there is no cure for HS, there are several different treatment options available, depending on the stage and severity of the condition. Laser-based treatments are becoming increasingly common.

HS occurs due to blocked hair follicles. That is why laser hair removal, which destroys the follicles, can be an effective treatment.

Laser hair removal uses a beam of intense light to target the hair follicle roots. The light produces heat that causes permanent damage to the follicle and may stop hair growth.

Laser therapies can also be effective at reducing the number of HS flare-ups by reducing the amount of follicles, sebaceous glands, and bacteria in the affected areas.

Medication and surgical interventions may not be successful in preventing future recurrence of HS flares, or slowing the progression of the disease.

Laser therapies may provide an alternative when other treatment options do not prove helpful.

Types of lasers

Laser therapies most commonly use the following lasers to treat HS:

  • Carbon dioxide (CO2) laser: This gas laser emits a powerful beam of light, vaporizing and destroying the affected tissue. In use since the late 1980s, it can produce long-term remissions. Several studies have shown consistently positive outcomes for the use of laser therapy in patients with Hurley stage 2 and Hurley stage 3 disease.
  • Nd:YAG laser: This infrared laser penetrates more deeply into the skin than other lasers, targeting the hair and follicle. It seems to work best for HS, especially in areas of the skin with dark and thick hair.
  • Intense pulsed light (IPL) therapy: Instead of focusing one beam of light, this treatment uses beams of different wavelengths to target the hair and follicles.

Other lasers in use to treat HS are alexandrite and diode lasers.

Similar treatments for HS include broadband light, radiofrequency, and photodynamic therapy. However, they are less common.

Laser hair removal seems to improve HS symptoms and cause few side effects.

This type of treatment usually works best for people with fair skin and dark hair. This is because the laser needs to be able to distinguish between skin and hair. As a result, laser hair removal may not be as effective for people with fair skin whose hair is blond or gray, for example.

Both long-pulsed Nd:YAG and IPL lasers are a safe treatment option for people with dark skin. However, a 2011 trial found the Nd:YAG laser to be more effective.

It is important to note that laser therapy may not be suitable for every person with HS. A doctor can advise whether this type of treatment may be helpful based on the stage and symptoms of the condition.

Moreover, although studies on some laser therapies, including CO2 lasers, show promising results, the numbers of study participants have been relatively small. There is therefore a need for larger-scale studies on these treatments.

In some cases, laser therapy may increase inflammation and aggravate the disease. It can also intensify any existing irritation from the shaving that is necessary prior to laser hair removal.

A 2012 study reports that some people using the Nd:YAG laser experienced a temporary increase in pain and inflammation in the first week following treatment. However, these symptoms subsided shortly afterward, with favorable results.

Moreover, some people with Hurley stage 3 disease may find laser therapy painful or ineffective, because lasers cannot easily penetrate scar tissue.

It is therefore important to consult a doctor before beginning any new course of treatment.

The number of treatments a person may need will vary depending on the level and severity of HS.

According to the American Academy of Dermatology, most patients require three laser treatments, on average. These treatments take place once every 4–6 weeks, and improvement might not be noticeable until after 1 month.

What is more, the treatment can be expensive. Insurance companies consider laser hair removal to be a cosmetic procedure, and therefore they usually do not cover the cost of it.

The American Society of Plastic Surgeons states the average cost of laser hair removal in 2019 was $285 per session. However, costs can differ depending on which area of the body requires treatment, and where a person with HS receives the therapy.

That said, a 2009 study notes that laser hair removal may be more affordable than other inpatient treatment options.

HS can be a painful condition with treatment options providing varying levels of success.

Laser hair removal is becoming more and more popular as a treatment for HS. It is of note, however, that while it may be suitable for some people, it may prove ineffective for others.

People with HS who are considering laser therapy should seek guidance from a doctor.

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