Conference Coverage

CO2 laser excision therapy for hidradenitis suppurativa shows no keloid risk


 

AT SOCS 2022

– The use of carbon dioxide (CO2) laser excision therapy for hidradenitis suppurativa (HS) is not associated with an increased risk for the development of keloids, new research shows.

“With keloids disproportionately affecting Black and other skin of color patients, denying treatment on a notion that lacks evidentiary support further potentiates the health disparities experienced by these marginalized groups,” the researchers reported at the Annual Meeting of the Skin of Color Society Scientific Symposium (SOCS) 2022. In their retrospective study of 129 patients with HS treated with CO2 laser, “there were no cases of keloid formation,” they say.

HS, a potentially debilitating chronic inflammatory condition that involves painful nodules, boils, and abscesses, is often refractory to standard treatment. CO2 laser excision therapy has yielded favorable outcomes in some studies.

Although CO2 laser therapy is also used to treat keloids, some clinicians hesitate to use this treatment in these patients because of concerns that its use for treating HS could trigger the development of keloids.

“Many patients come in telling us they were denied [CO2 laser] surgery due to keloids,” senior author Iltefat Hamzavi, MD, a senior staff physician in the Department of Dermatology at the Henry Ford Health System, Detroit, told this news organization.

Dr. Iltefat Hamzavi dermatologist, Henry Ford Health System, Detroit, Mich.

Dr. Iltefat H. Hamzavi

Although patients with HS are commonly treated with CO2 laser excision in his department, this treatment approach “is underused nationally,” he said.

“Of note, the sinus tunnels of hidradenitis suppurativa can look like keloids, so this might drive surgeons away from treating [those] lesions,” Dr. Hamzavi said.

To further evaluate the risk of developing keloids with the treatment, Dr. Hamzavi and his colleagues conducted a retrospective review of 129 patients with HS treated at Henry Ford who had undergone follicular destruction with CO2 laser between 2014 and 2021; 102 (79%) patients were female. The mean age was about 38 years (range, 15-78 years).

Of the patients, almost half were Black, almost 40% were White, 5% were Asian, and 3% were of unknown ethnicity.

Medical records of nine patients included diagnoses of keloids or hypertrophic scars. Further review indicated that none of the diagnoses were for keloids but were for hypertrophic scars, hypertrophic granulation tissue, an HS nodule, or contracture scar, the authors report.

“While the emergence of hypertrophic scars, hypertrophic granulation tissue, and scar contracture following CO2 laser excision therapy for hidradenitis suppurativa has been documented in the literature, existing evidence does not support postoperative keloid formation,” the authors conclude.

Because healing time with CO2 laser treatment is prolonged and there is an increase in risk of adverse events, Dr. Hamzavi underscored that “safety protocols for CO2 lasers should be followed, and wound prep instructions should be provided along with counseling on healing times.”

Regarding patient selection, he noted that “the disease should be medically stable with reduction in drainage to help control postop bleeding risk.”

The findings of the study are supported by a recent systematic review that compared outcomes and adverse effects of treatment with ablative laser therapies with nonablative lasers for skin resurfacing. The review included 34 studies and involved 1,093 patients. The conditions that were treated ranged from photodamage and acne scars to HS and post-traumatic scarring from basal cell carcinoma excision.

That review found that overall, rates of adverse events were higher with nonablative therapies (12.2%, 31 events), compared with ablative laser therapy, such as with CO2 laser (8.28%, 81 events). In addition, when transient events were excluded, ablative lasers were associated with fewer complications overall, compared with nonablative lasers (2.56% vs. 7.48%).

The authors conclude: “It is our hope that this study will facilitate continued research in this domain in an effort to combat these inequities and improve access to CO2 excision or standardized excisional therapy for hidradenitis suppurativa treatment.”

Dr. Hamzavi and the other authors have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Recommended Reading

Phase 2 studies of novel JAK1 inhibitor for HS show promise
MDedge Dermatology
Lipedema: A potentially devastating, often unrecognized disease
MDedge Dermatology
​​​​​​​A 34-year-old male presented with 10 days of a pruritic rash
MDedge Dermatology
Combination treatments a must for the war on warts
MDedge Dermatology
An 11-year-old female presented with skin discoloration on her back
MDedge Dermatology
A 31-year-old female presented with a burning rash on upper arms, groin, and axillae
MDedge Dermatology
Adverse skin effects of cancer immunotherapy reviewed
MDedge Dermatology
Novel isotretinoin ointment for congenital ichthyosis shows promise
MDedge Dermatology
Dupilumab treats itch and clears lesions in prurigo nodularis patients
MDedge Dermatology
For pemphigus, rituximab is first line, expert says
MDedge Dermatology