Mulitcultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.
J Am Acad Dermatol. 2010 Apr;62(4):637-45. doi: 10.1016/j.jaad.2009.07.048.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the intertriginous areas.
We sought to conduct clinical and histopathologic evaluation of the efficacy of long-pulsed neodymium:yttrium-aluminium-garnet laser treatment for HS.
We conducted a prospective, randomized, right-left within-patient controlled trial for HS (n = 22). Four monthly laser sessions were performed. Disease activity was measured at baseline, and treatment response was assessed before each laser session and monthly for 2 months after the completion of laser treatment, using a modified scoring system based on Sartorius score. Histologic examination was performed at baseline, immediately after laser treatment, and at 1 and 4 weeks after treatment. A patient questionnaire was circulated on the last visit to assess patients' level of satisfaction.
There was progressive improvement in disease activity, most significantly during the 4 months of treatment, which was maintained during the 2-month posttreatment follow-up period. Averaged over all anatomic sites, the percent improvement was 72.7% on the laser treated side, and 22.9% on the control side (P < .05). Histologic examination showed an initial acute neutrophilic infiltrate. Granulomatous inflammation was present on follow-up biopsy specimens 4 weeks later. An inflammatory infiltrate surrounded the hair shaft remnants, denoting destruction of hair follicles.
Small sample size was a limitation.
Long-pulsed neodymium:yttrium-aluminium-garnet laser, together with topical benzoyl peroxide and clindamycin, is significantly more effective than topical benzoyl peroxide and clindamycin alone for the treatment of HS. Preliminary review of histopathology suggests the mechanism of action is destruction of the hair follicle. The overall success of the treatment in both clearing pre-existing lesions and preventing new eruptions, coupled with high patient satisfaction, makes the neodymium:yttrium-aluminium-garnet laser a promising treatment advance for this highly disabling condition.
化脓性汗腺炎（HS）是一种涉及间擦部位的慢性炎症性疾病。
我们旨在评估长脉冲钇铝石榴石激光治疗 HS 的临床和组织病理学疗效。
我们对 22 例 HS 患者进行了前瞻性、随机、自身左右对照试验。共进行 4 次激光治疗，每次间隔 1 个月。在基线、每次激光治疗前和激光治疗结束后 2 个月，采用基于 Sartorius 评分的改良评分系统评估疾病活动度。在基线、激光治疗后即刻、治疗后 1 周和 4 周进行组织学检查。在最后一次就诊时，发放患者问卷评估患者的满意度。
疾病活动度逐渐改善，治疗期间改善最为显著，激光治疗结束后 2 个月随访期仍持续改善。在所有解剖部位，激光治疗侧的改善率为 72.7%，而对照侧为 22.9%（P＜.05）。组织学检查显示初始存在急性中性粒细胞浸润。4 周后，活检显示肉芽肿性炎症。炎症浸润围绕着残留的毛囊，提示毛囊破坏。
样本量小是一个局限性。
长脉冲钇铝石榴石激光联合外用过氧化苯甲酰和克林霉素治疗化脓性汗腺炎的疗效明显优于单纯外用过氧化苯甲酰和克林霉素。组织病理学初步检查提示其作用机制为破坏毛囊。该治疗方法不仅能清除原有皮损，还能预防新皮损出现，且患者满意度高，这使得钇铝石榴石激光成为治疗这种高度致残性疾病的一种有前途的治疗方法。
