Skip to main content

Advertisement

SpringerLink
Log in

Effects of the modified excision combined with bidirectional photodynamic therapy on refractory hidradenitis suppurativa: a retrospective study

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

To describe the clinical features of refractory hidradenitis suppurativa (HS) patients (Hurley stageII and stage III) and evaluate the efficacy of combined treatment of the modified excision with bidirectional photodynamic therapy (PDT). A retrospective, multicenter study was conducted in 35 refractory HS patients. They were treated with the modified excision combined with bidirectional PDT. The outcomes, patients’ satisfaction, adverse effects, and the Dermatology Life Quality Index (DLQI) were observed. There were more males than females (6:1). The axilla was the most frequently affected region (37.5%). All patients had experienced treatment failures before and had good response to our combined therapy (clearance rate > 75%). The average time required for complete wound healing was 11 days. After 1 year of follow-up, no significant recurrence was observed. The DLQI decreased significantly after the combined treatment. The comprehensive evaluation of scar and the deformation showed good cosmetic results after treatment. Reversible adverse events such as small patchy blackness, necrosis, or ulcer in the tip of the flap occurred in six patients (17.1%). Of the 35 patients, 30 were very satisfied with the treatment. This case series finds that the modified excision combined with bidirectional PDT may hold promise for radical treatment of Hurley stage II and stage III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data cannot be publicly available due to ethical restrictions or patient privacy.

References

  1. Jemec GBE (2012) Clinical practice. Hidradenitis suppurativa. N Engl J Med 366:158–164

    Article  CAS  Google Scholar 

  2. Jemec GBE, Kimball AB (2015) Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol 73:S4–S7

    Article  Google Scholar 

  3. Ingram JR, Jenkins-Jones S, Knipe DW, Morgan CLI, Cannings-John R, Pigue V (2018) Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol 178:917–924

    Article  CAS  Google Scholar 

  4. Sampogna F, Fania L, Mazzanti C et al (2020) The impact of hidradenitis suppurativa on general health is higher than that of hypertension, congestive heart failure, type 2 diabetes, myocardial infarction and depression. J Eur Acad Dermatol Venereol 34:e386–e388

    Article  CAS  Google Scholar 

  5. Jalenques I, Ciortianu L, Pereira B, D’Incan M, Lauron S, Rondepierre F (2020) The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: systematic review and meta-analysis. J Am Acad Dermatol 83:542–553

    Article  Google Scholar 

  6. Goldburg SR, Strober BE, Payette MJ (2020) Part 2. Current and emerging treatments for hidradenitis suppurativa. J Am Acad Dermatol 82:1061–1082

    Article  CAS  Google Scholar 

  7. Lyons AB, Shabeeb N, Nicholson CL, Braunberger TL, Peacock A, Hamzavi HI (2020) Emerging medical treatments for hidradenitis suppurativa. J Am Acad Dermatol 83:554–562

    Article  CAS  Google Scholar 

  8. Saunte DML, Jemec GBE (2017) Hidradenitis suppurativa: advances in diagnosis and treatment. JAMA 318:2019–2032

    Article  Google Scholar 

  9. Ellis LZ (2012) Hidradenitis suppurativa: surgical and other management techniques. Dermatol Surg 38:517–536

    Article  CAS  Google Scholar 

  10. Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I (2020) Medical and surgical management of hidradenitis suppurativa: a review of international treatment guidelines and implementation in general dermatology practice. Dermatology 236:393–412

    Article  CAS  Google Scholar 

  11. Zouboulis CC, Desai N, Emtestam L et al (2015) European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol 29:619–644

    Article  CAS  Google Scholar 

  12. Scuderi N, Monfrecola A, Dessy LA, Fabbrocini G, Megna M, Monfrecola G (2017) Medical and surgical treatment of hidradenitis suppurativa: a review. Skin Appendage Disord 3:95–110

    Article  Google Scholar 

  13. Gracia Cazaña T, BerdelDíaz LV, Martín Sánchez JI, QuerolNasarre I, Gilaberte Y (2020) Systematic review of light-based treatments for hidradenitis suppurativa. Actas Dermosifiliogr 111:89–106

    Article  Google Scholar 

  14. Wen X, Li Y, Hamblin MR (2017) Photodynamic therapy in dermatology beyond non-melanoma cancer: an update. Photodiagnosis Photodyn Ther 19:140–152

    Article  CAS  Google Scholar 

  15. Hurley HJ (1996) Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach. In: Roenigk RK, Roenigk HH (eds) Dermatologic surgery. Marcel Dekker, New York, pp 623–645

    Google Scholar 

  16. Sotiriou E, Apalla Z, Maliamani F, Ioannides D (2009) Treatment of recalcitrant hidradenitis suppurativa with photodynamic therapy: report of five cases. Clin Exp Dermatol 34:e235-236

    Article  CAS  Google Scholar 

  17. Andino Navarrete R, Hasson Nisis A, Parra Cares J (2014) Effectiveness of 5-aminolevulinic acid photodynamic therapy in the treatment of hidradenitis suppurativa: a report of 5 cases. Actas Dermosifiliogr 105:614–617

    Article  CAS  Google Scholar 

  18. Zhao S, Liu D, Shi W et al (2020) Efficacy of a new therapeutic option for vulvar intraepithelial neoplasia: superficial shaving combined with photodynamic therapy. Lasers Surg Med 52:488–495

    Article  Google Scholar 

  19. Finlay V, Burrows S, Kendell R et al (2017) Modified Vancouver Scar Scale score is linked with quality of life after burn. Burns 43:741–746

    Article  Google Scholar 

  20. Yang JH, Moon J, Kye YC et al (2018) Demographic and clinical features of hidradenitis suppurativa in Korea. J Dermatol 45:1389–1395

    Article  Google Scholar 

  21. Bieniek A, Matusiak Ł, Chlebicka I (2013) Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non-melanoma skin cancers. J Eur Acad Dermatol Venereol 27:1015–1021

    Article  CAS  Google Scholar 

  22. Alharbi M, Perignon D, Assaf N, Qassemyar Q, Elsamad Y, Sinna R (2014) Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa. Ann Chir Plast Esthet 59:29–34

    Article  CAS  Google Scholar 

  23. Garcia VG, de Lima MA, Okamoto T et al (2010) Effect of photodynamic therapy on the healing of cutaneous third-degree-burn: histological study in rats. Lasers Med Sci 25:221–228

    Article  Google Scholar 

  24. Garrier J, Bezdetnaya L, Barlier C, Gräfe S, Guillemin F, D’Hallewin MA (2011) Foslip(R)-based photodynamic therapy as a means to improve wound healing. Photodiagnosis Photodyn Ther 8:321–327

    Article  CAS  Google Scholar 

  25. Eming SA, Krieg T, Davidson JM (2007) Inflammation in wound repair: molecular and cellular mechanisms. J Invest Dermatol 127:514–525

    Article  CAS  Google Scholar 

  26. Romanowski KS, Fagin A, Werling B et al (2017) Surgical management of hidradenitis suppurativa: a 14-year retrospective review of 98 consecutive patients. J Burn Care Res 38:365–370

    Article  Google Scholar 

  27. Mehdizadeh A, Hazen PG, Bechara FG et al (2015) Recurrence of hidradenitis suppurativa after surgical management: a systematic review and meta-analysis. J Am Acad Dermatol 73:S70-77

    Article  Google Scholar 

Download references

Acknowledgements

We want to express deep appreciation for your help to Professor Chen Xiang in Department of Dermatology, Xiangya Hospital, Central South University and Tao Juan in Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The patients in this manuscript have given written informed consent to publication of their case details.

Funding

This work was supported by the Fundamental Research Funds for the Central Universities (3332020062).

Author information

Author notes

  1. Wenbo Bu and Shuang Zhao contributed equally to this article.

Authors and Affiliations

  1. Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China

    Wenbo Bu, Qian Zhang & Fang Fang

  2. Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, China

    Shuang Zhao

  3. Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Liu Yang

Authors
  1. Wenbo Bu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qian Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fang Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Wenbo Bu, Shuang Zhao, Qian Zhang, and Fang Fang. The first draft of the manuscript was written by Liu Yang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Fang Fang or Liu Yang.

Ethics declarations

Ethics approval

The protocol was validated by the ethics committee. All procedures performed in studies involving human participants were in accordance with the Helsinki Declaration.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bu, W., Zhao, S., Zhang, Q. et al. Effects of the modified excision combined with bidirectional photodynamic therapy on refractory hidradenitis suppurativa: a retrospective study. Lasers Med Sci 37, 2865–2872 (2022). https://doi.org/10.1007/s10103-022-03555-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-022-03555-7

Keywords

Search

Navigation