Hailey-Hailey Disease Severity Improved Using CO2 Lasers

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Although there are treatments available for hailey-hailey disease (HHD), they are often complex and multiple therapies have been reported to temporarily improve symptoms, but do not modify the natural course of the disease.¹ Some researchers have reported on the efficacy of ablative carbon dioxide laser achieving “considerable improvement” in medium to long-term follow-up,² leading to a recent study investigating the influence CO₂ laser modifies the quality of life (QoL) of patients with HHD.³ Researchers found that laser intervention "significantly improved the QoL of patients with HHD, with an absence of symptoms allowing them to live without restriction.”

Methods

Twelve patients with HHD who underwent CO₂ laser at the University of Navarra Clinicin Navarra, Spain, between September and December 2021 were included in the study. Researchers employed the skindex-29 given the absence of a scale for HHD, due to its success in assessing QOL across various cutaneous disorders. The questionnaire comprises three core dimensions – functional, emotional, and symptomatic – with each item employing a Likert-type response ranging from 0 to 4, covering information within the preceding month. They administered the questionnaire before the laser intervention, after 6 months of treatment, and after a year of follow-up.The anchoring method was used to assess the severity of the disease, deeming a score of 44 or higher as indicative of severe impairment.

Researchers used the ablative AcuPulse CO₂ laser 10,600 nm with the following parameters: Scanner F200, shape size 8 mm, depth 4, time 0.50 seconds, power 24 watts. In each area they treated, they administered 3 passes until they reached slight bleeding. They then reported applying topical medium-potency steroids and petrolatum gauze over the area.

Results

The study, made up of half men and half women ages 37 to 81 years (mean 59), stated that the groin was the most frequently affected area (92%), followed by the genitals (58%), the armpits (42%), the neck and the buttocks (25%). All patients reported having a history of using topical (92%) and systemic corticosteroids (83%), topical calcineurin inhibitors (67%) and systemic immunosuppressants (33%). Researchers found that the average score for the basal skindex-29 was 55 points, reaching 22 points at 6 months after treatment and 19 points after one year of follow-up.

Researchers stated that all patients displayed elevated baseline skindex-29 results, with nine scoring above 44. After a single laser session and 6 months of follow-up, the entire cohort reported “significant” QoL improvement, which was reflected in the skindex-29 score that persisted throughout the year. Researchers observed no recurrences, however 4 of 13 patients requiredadditional laser treatment for isolated and mildly symptomatic areas near previously treated folds. The study reported 1 patient experiencing a late relapse surrounding a previously treated zone that resolved and remained free of relapse after an additional laser session.

Conclusion

Researchers found that CO₂ laser treatment in patients with HHD had positive QoL results, including absence of symptoms, providing the opportunity to live a normal life without restrictions. While there are other studies into the QoL of patients with HHD, such as Gisondi et al, who reported severe QoL impairment in patients with the disease, this is the first study to investigate the impact CO2 laser treatment could have on QoL.⁴ The completed study determined the usefulness of skindex-29 in assessing QoL in patient with HHD while confirming the long-term efficacy and positive impact of the CO₂ laser intervention on the QoL of these patients.

References

1. Rogner DF, Lammer J, Zink A, et al. Darier and hailey-hailey disease: update 2021. J Dtsch Dermatol Ges. 2021; 19(10): 1478-1501. doi: 10.1111/ddg.14619
2. Pretel-Irazabal M, Lera-Imbuluzqueta JM, España-Alonso A. Carbon dioxide laser treatment in hailey-hailey disease: a series of 8 patients. Actas Dermosifiliogr. 2013;104(4):325-333. doi:10.1016/j.adengl.2013.03.004
3. AntoñanzasJ, Salido-Vallejo R, Morelló-Vicente A, et al. Improvement in quality of life in patients with hailey-hailey disease treated with ablative CO2 laser. JDDG. https://doi.org/10.1111/ddg.15390
4. Gisondi P, Sampogna F, Annessi G, et al. Severe impairment of quality of life in hailey-hailey disease. Acta Derm Venereol. 2005;85(2):132-135. doi:10.1080/00015550410025462