Diode Laser Therapy as an Adjunct to Minimally Invasive Therapy for Hidradenitis Suppurativa

Introduction: Hidradenitis Suppurativa (HS) is a chronic, multifactorial inflammatory skin condition characterized by tissue destruction, painful lesions and frequent recurrences. Surgical resection can help achieve long term remission with traditional surgical interventions like radical excision, deroofing, incision and drainage. Diode laser therapy, a novel therapeutic approach accelerates wound healing by selective ablation and collapse of existing scars . This would translate as a minimally invasive deroofing tech- nique performed over a few sessions based on severity. This combined with minimally invasive techniques for HS (MITHS), represents a promising adjunct for enhancing wound healing and symptom resolution. Methods: We conducted a retrospective single center, single surgeon study between January 2022 and January 2024 involving 44 HS patients (Hurley stages 2-3) who underwent MITHS with a 1470 nm diode laser ablation. Hidradenitis tracts were ablated intraoperatively using the la- sers. Outcomes were assessed based on symptom resolution: full, partial, or unresolved which was self reported. Patient demographics, prior treat- ment history, lesion location, and adverse effects were also recorded. Results: Out of 44 patients, 50 procedures performed were MITHS. 60% (n=27) of procedures led to complete resolution, 40% led to partial resolution (n=18) . After subsequent treatments, the final results were 64% procedures (n=32) with complete and 30% with partial resolution (n=15) respectively. 6% (n=3) of patients were lost to follow up. No patients reported worsening symptoms, and adverse effects were minimal and transient, with two cases of reversible upper extremity nerve palsy. The procedure was performed under local anesthesia and well-tolerated. Discussion: Diode laser therapy as an adjunct to MITHS demonstrates high efficacy, minimal morbidity, and short recovery times, providing a viable alternative to more invasive surgical approaches for HS. This would serve as a key therapeutic tool to achieve remission or even complete cure in patients with moderate-severe disease. These results highlight the po- tential for diode laser therapy to address unmet therapeutic needs in this population. Further prospective studies are warranted to validate its role in HS management and to refine its application in multidisciplinary care.