Nonablative technologies and the HS patient

Nonablative lasers, which are essentially modified hair removal lasers, offer treatment benefits for HS patients with stage 1 or stage 2 disease, according to Iltefat H. Hamzavi, M.D., a dermatologist at Hamzavi Dermatology in Fort Gratiot, Mich., and president of the Hidradenitis Suppurativa Foundation, who also talked about the use of nonablative lasers to treat HS patients during this year’s AAD annual meeting.

Published studies suggest these lasers achieve from 65% to 75% improvement in the axilla among patients with nodular Hurley stage 1 or 2 HS. And dermatologists tend to get about 55% improvement using these lasers in the inframammary zone, he says.

The consensus is that nonablative lasers are helpful in preventing new HS nodules, but they’re not helpful in treating patients with sinus tract, Dr. Hamzavi says.

“So, if you have a full-blown sinus tract, it’s not as likely to work. And if you have significant scarring, early stage 3, these are not the devices to use. But you can certainly use them in your population to try and prevent new lesions from developing,” he says.

Dr. Hamzavi, who uses a long-pulsed Nd: YAG laser to treat HS nodules, says there are reports of intense pulsed light (IPL) being effective, and studies and case reports suggest the alexandrite laser helps some HS patients.

“For the most part, it’s any device that can work well on laser hair removal, but the YAG has most of the research behind it,” he says.

Dr. Hamzavi offers these HS nonablative treatment best practices: Dermatologists can use the same settings for these lasers on all skin types. Treat the entire zone where people tend to break out with their HS lesions. Double pulse the individual nodules. Warn patients that they may flair up a week or two after treatment. And plan on three treatments.

“You can’t expect them to get better with just one treatment,” he says. “You can use nonablative technologies as primary or adjunctive agents. In stage 1 and stage 2 nonablative technologies are really helpful in reducing the need for antibiotics. In stage 3, they can be helpful in preventing new lesions from developing in areas that are not scarred down yet.”

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