Department of Dermatology, Yale University, New Haven, Connecticut, USA.
Department of Dermatology, Medstar Georgetown University Hospital, Washington, District of Columbia, USA.
Lasers Surg Med. 2024 Jul;56(5):425-436. doi: 10.1002/lsm.23796. Epub 2024 May 20.
Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules, draining tunnels, and fibrotic scarring in intertriginous, hair-bearing areas. The pathogenesis involves follicular occlusion and subsequent rupture, leading to uncontrolled inflammation. Treatment options for HS are limited and lack universal effectiveness. Laser hair removal (LHR) has been explored as a potential treatment; however, the efficacy and appropriate laser modalities remain unclear. This systematic review examined the efficacy and adverse effects of LHR in HS.
A comprehensive literature search was conducted from inception to September 2023 in Ovid MEDLINE, Ovid Embase, and The Cochrane Library (Wiley) with predefined inclusion and exclusion criteria, and a meta-analysis was conducted.
Ten studies were selected (n = 227 total patients) and included six randomized controlled trials, two nonrandomized experimental studies, and two case series. Various laser modalities, including long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) (n = 115), intense pulsed light (n = 18), Alexandrite (n = 54), intralesional 1064 nm diode (n = 20), and combined fractional CO and long-pulsed Nd:YAG laser (n = 20), consistently demonstrated significant improvement in HS disease severity, irrespective of the disease scoring method used. Minimal adverse effects (primarily mild pain and erythema) were reported. A meta-analysis of three studies utilizing long-pulsed Nd:YAG laser demonstrated a standardized mean difference in disease severity of -1.68 (95% confidence interval: -2.99; -0.37), favoring treatment with LHR for HS.
Hair follicles are key in HS pathogenesis and all included studies showed a significant improvement in HS disease severity after LHR regardless of the laser device used, likely related to hair follicle unit destruction. HS is a complex and heterogenous condition, and multiple disease scoring methods complicate outcome comparisons across studies. However, LHR, utilizing various techniques, is an effective treatment option for HS with minimal adverse effects.
化脓性汗腺炎（HS）是一种慢性炎症性疾病，其特征为在易摩擦和多毛区域出现疼痛性结节、窦道和纤维性瘢痕。发病机制涉及毛囊阻塞和随后的破裂，导致不受控制的炎症。HS 的治疗选择有限，缺乏普遍有效性。激光脱毛（LHR）已被探索作为一种潜在的治疗方法；然而，其疗效和适当的激光方式仍不清楚。本系统评价检查了 LHR 在 HS 中的疗效和不良反应。
从 Ovid MEDLINE、Ovid Embase 和 The Cochrane Library（Wiley）中进行了全面的文献检索，检索时间从成立到 2023 年 9 月，使用了预设的纳入和排除标准，并进行了荟萃分析。
选择了 10 项研究（共 227 名患者），其中包括 6 项随机对照试验、2 项非随机实验研究和 2 项病例系列研究。各种激光模式，包括长脉冲掺钕钇铝石榴石（Nd:YAG）（n=115）、强脉冲光（n=18）、亚历山大（n=54）、1064nm 二极管腔内（n=20）和联合分段 CO 和长脉冲 Nd:YAG 激光（n=20），均显示出 HS 疾病严重程度的显著改善，无论使用何种疾病评分方法。报告了轻微的不良反应（主要是轻度疼痛和红斑）。三项利用长脉冲 Nd:YAG 激光的研究的荟萃分析显示，疾病严重程度的标准化均数差为-1.68（95%置信区间：-2.99；-0.37），支持 LHR 治疗 HS。
毛囊是 HS 发病机制的关键，所有纳入的研究都显示 LHR 后 HS 疾病严重程度显著改善，无论使用何种激光设备，这可能与毛囊单位破坏有关。HS 是一种复杂且异质的疾病，多种疾病评分方法使研究间的结果比较复杂化。然而，LHR 利用各种技术是一种有效的 HS 治疗选择，不良反应极小。
