CO2 Laser Surgical Excision for Hidradenitis Suppurativa

CO2 Laser Excision vs. Other Treatments

Traditional Surgery

Traditional surgical excision involves removing affected areas of the skin in a deroofing or excision. This treatment can be successful in severe cases, but it has a higher risk of recurrence compared to CO2 laser excision and longer recovery times. Also a larger area may require undergoing general anesthesia while CO2 excision is an outpatient procedure with light sedation.

Corticosteroid Injections

Corticosteroid injections can help reduce inflammation and swelling, but the effects are often temporary. Steroid injections also do not treat sinus tracts and scarring.

Antibiotics

Antibiotics can be effective in treating hidradenitis suppurativa, but they should be used cautiously to prevent the development of antibiotic-resistant bacteria. Antibiotics can be used as a bridge to surgery at times to help with inflammation.

Biologic Medications

Biologic medications such as adalimumab, infliximab, secukinmab, ustekinumab all work by targeting specific pathways and molecules that are implicated in HS. These medications are important in reducing levels of inflammation and HS disease activity overall but may not work for everyone. Importantly, they will not reverse any scarring or sinus tunnels that have already formed.

Alternative Medicine and Diet

Lifestyle modifications such as weight loss and quitting smoking have been recommended to help with HS. Eliminating dairy may help some patients with HS and having a low glycemic diet may also improvement HS. Eliminating wheat and brewer's yeast has also helped some patients. Supplements such as Curcumin, vitamin D, and Zinc may be beneficial. Evidence is mixed but may be helpful to some patients.

Silfvast-Kaiser A, Youssef R, Paek SY. Diet in hidradenitis suppurativa: a review of published and lay literature. Int J Dermatol. 2019;58(11):1225-1230. doi:10.1111/ijd.14465.

Results Following CO2 Laser Excision of HS in the Underarm

Preparation for the Procedure

Before the Treatment

Before you undergo CO2 laser treatment, you will need to avoid certain medications such as aspirin, ibuprofen, and blood thinners. You must have a driver the day of surgery, assistance with wound care, and dressing supplies. Please let your care team know if you have any drug allergies.

Day of the Procedure

Arrive promptly at 8am. Remember to pick up your medications from the pharmacy. Eat a healthy breakfast before you come in. Wear comfortable, loose-fitting clothing. You can bring headphones to listen to music during the surgery if you would like.

During the procedure

There will be ultrasound imaging performed of the area first. You will be given oral medication to relax and reduce discomfort. The laser procedure typically takes between 30-60 minutes and is performed under local anesthesia. The laser is applied over the affected area, and you may feel a warm sensation on your skin.

After the procedure

After the treatment, you may experience some redness, swelling, and mild discomfort. Your doctor may prescribe pain medication and topical antibiotics to prevent infection. It is important to follow your doctor's instructions carefully to ensure proper healing. The dedicated HS wound care nurses will go over specific instructions and dressings for your wound.

What to Expect during Recovery

Your Wound

You will be asked to look at your wound for the 1st time after surgery. This will allow you to ask questions and to understand the appropriate appearance of your wound. Your wound will appear graphic and may be disturbing for you to see. Please be assured that each individual response to seeing your wound is normal and understandable.

Healing Process

Our team will go over specific wound care instructions to keep the wound moist. Your dressings will stay in place until you return for a 24 hour follow up. It is recommended to follow up based on the schedule given to you by your care team. The wound diameter should reduce in size by 25% every 2 weeks. Most patients within 12 weeks, but some patients may take up to 6 months to heal. Patients will find that they feel a dramatic improvement from their pain and drainage from their HS within 2 weeks after surgery.

Potential Side Effects

Although rare, side effects can occur after the treatment, including hyperpigmentation, hypopigmentation, and scarring. If the area of HS is in the underarm, it is important to begin range of motion exercises when directed to make sure the skin heals properly to prevent any excessive contraction.

Diet

While in the wound healing process, it is important to consume extra protein, about 1.5 grams of protein per kilogram per day, to encourage the body to create new tissue to heal.

Controlling Comorbidities

While healing, if you have diabetes, it is important to make sure your blood sugars are well controlled to help the body heal as fast as it can.

Moisture Balance

During your visits you will receive teaching from our team about wound care for your surgical wound. It is important to keep the wound bed moist with petrolatum and then to slowly decrease the amount as the wound begins to heal.

FAQs