Systematic review of laser and Light-Based procedural treatments for hidradenitis suppurativa

Background Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease involving the follicular epithelium that significantly impairs quality of life. Treatment varies by stage and includes antibiotics, immunosuppressants, biologics, and surgery for severe tissue damage. Laser therapies like CO2, Nd:YAG and IPL offer non-invasive options. Objective This systematic review evaluates the efficacy and safety of procedural treatment, including IPL, CO2, and Nd: YAG, in the treatment of hidradenitis suppurativa. Methods preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies published from 2010 to 2025 were searched in Scopus, Web of Science, and PubMed databases using predefined terms. Inclusion criteria comprised English-language studies investigating laser therapies, including IPL, CO2, and Nd: YAG lasers, for hidradenitis suppurativa in comparative and randomized controlled trials. Data extraction covered study characteristics, patient demographics, laser parameters, and treatment outcomes. Quality assessment was performed using the Cochrane Risk of Bias (ROB 2) tool. Results Out of 2,833 initially retrieved records, 8 studies involving a total of 181 patients met the inclusion criteria. The studies investigated multiple laser-based interventions: 2 focused on Intense Pulsed Light (IPL), including one study using IPL alone and another combining IPL with Pulsed Dye Laser (PDL); 2 studies examined LAight^® therapy (a combination of IPL and radiofrequency), including comparisons with topical clindamycin 0.1%; and 4 studies investigated Nd: YAG laser, including combined protocols with CO₂ laser, benzoyl peroxide, and clindamycin. IPL monotherapy achieved a 67% hidradenitis suppurativa clinical response (HiSCR) rate and reduced median modified severity scores from 8.5 to 4.5 (p = 0.006). LAight^® combined with topical clindamycin produced a − 60.0% ± 6.7% reduction in IHS4 versus − 17.8% ± 5.6% with clindamycin alone (p < 0.001), with HiSCR responses of 63% versus 36% at week 16. Nd: YAG laser yielded a mean HS-LASI score decrease of 31.6% after two sessions (p < 0.001) and, in a randomized within-patient trial, a 72.7% ± 13.0% lesion score reduction versus 22.9% ± 38.9% with topical therapy (p < 0.001). Fractional CO₂ + Nd: YAG combination therapy achieved 90% ± 20.5% improvement versus 70.7% ± 23.6% with Nd: YAG alone, with 80% of treated sides rated “clear” on physician global assessment at two weeks (55% maintained at three months). IPL–PDT using NMB gel led to a 77.3% ± 18.9% lesion reduction versus 44.1% ± 28.2% with FMB gel (p < 0.01). Adverse effects—including erythema, mild burns, transient pain, and tenderness—were generally mild and self-limited, with no severe events reported. Conclusion Laser and light-based therapies, including long-pulsed Nd: YAG, fractional CO₂, IPL combined with radiofrequency (LAight^®), and photodynamic therapy, offer effective and safe options for managing hidradenitis suppurativa. Hair follicle–targeting lasers, particularly Nd: YAG, show sustained reductions in inflammatory lesions and lower recurrence compared to medical treatments alone. Ablative approaches like fractional CO₂ and IPL-RF complement these effects by improving scarring and accelerating lesion resolution. Photodynamic therapy shows potential but requires further validation in larger controlled trials. Adverse effects are generally mild and transient. Nonetheless, the heterogeneity of current studies and limited follow-up underscore the need for standardized protocols and robust randomized trials. Future research should aim to refine treatment strategies and integrate laser/light modalities with systemic and topical therapies to enhance long-term outcomes and quality of life.