Laserepilation bei Hidradenitis suppurativa/Acne inversa und Pilonidalsinus

Zusammenfassung

Bei der Hidradenitis suppurativa/Acne inversa (HS/AI) scheint die Laserepilation v. a. in initialen Stadien einen erfolgversprechenden Therapieansatz darzustellen. Beim Pilonidalsinus (PS) wird die Laserepilation überwiegend als adjuvante Therapie nach operativen Eingriffen zur Senkung der Rezidivrate empfohlen. Der Vergleich der Studienlage bei der HS/AI und dem PS zeigt, dass mehr Studien zur Laserepilation beim PS vorliegen. Die Arbeiten zur HS/AI weisen geringere Patientenzahlen und kürzere Nachbeobachtungszeiten auf. Auch gibt es bei der HS/AI bislang weder Untersuchungen zum Einsatz der Laserepilation als Rezidivprophylaxe, noch liegen Daten zum kombinierten Einsatz von Laserepilation und anderen konservativen Therapien, wie z. B. Antibiotika, vor.

Eine eindeutige Empfehlung bezüglich eines einheitlichen Therapieprotokolls lässt sich nach Durchsicht der Literatur aufgrund der heterogenen Behandlungsparameter (Anzahl der Sitzungen, Abstände zwischen den Sitzungen, Energieeinstellungen) nicht ableiten.

Zusammenfassend legen die Ergebnisse der durchgeführten Studien nahe, dass unabhängig vom eingesetzten Lasertyp die Laserepilation effektiv in der Behandlung der HS/AI und des PS zu sein scheint. Neben einem positiven Einfluss auf die Wundheilung deuten die Ergebnisse daraufhin, dass die Laserepilation die Rezidivrate und das Fortschreiten der Erkrankung positiv beeinflussen kann. Dabei war die Laserepilation in allen Studien einfach durchführbar und komplikationsarm.

Abstract

Hidradenitis suppurativa/Acne inversa (HS/AI) and pilonidal sinus (PS) are chronic inflammatory cutaneous disorders characterized by recurrent inflammation. Effective treatments are limited and relapse is frequent. The current data indicate the important role of the hair follicle in the pathogenesis of these conditions. Hence, a number of studies evaluated the effect of epilation using laser and intense pulsed light on the course of HS/AI and PS.

Our review of the literature revealed that in patients with HS/AI laser epilation is especially effective in early stages of the disease. In patients with PS the majority of studies recommend laser epilation as an adjunctive postoperative therapy to reduce the chance of recurrence.

As published treatment modalities including laser parameters, total number of laser treatments and interval between treatments are diverse a definite treatment protocol cannot be provided.

However, regardless of the laser system used the results of the reviewed studies indicate the beneficial effect of laser epilation on improving HS/AI and PS. 

In conclusion, laser epilation offers a safe and easy to use treatment option which enlarges the armamentarium in the treatment of patients with HS/AI and PS.

• Literatur

• 1 Wolkenstein P, Loundou A, Barrau K et al. Quality of life impairment in hidradenitis suppurativa: a study of 61 cases. J Am Acad Dermatol 2007; 56: 621-623
• 2 Jemec GB, Wulf HC. Patient-physician consensus on quality of life in dermatology. Clin Exp Dermatol 1996; 21: 177-179
• 3 Harrison BJ, Mudge M, Hughes LE. Recurrence after surgical treatment of hidradenitis suppurativa. Br Med J Clin Res Ed 1987; 294: 487-489
• 4 Zouboulis CC, Bechara FG, Fritz K et al. S1-Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa. JDDG 2012; 10: 1-31
• 5 Sellheyer K, Krahl D. “Hidradenitis suppurativa” is acne inversa! An appeal to (finally) abandon a misnomer.. Int J Dermatol 2005; 44: 535-540
• 6 Sellheyer K, Krahl D. What causes acne inversa (or hidradenitis suppurativa)? – the debate continues.. J Cutan Pathol 2008; 35: 701-703
• 7 Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 2009; 60: 539-561 quiz 562 – 563
• 8 Sartorius K, Lapins J, Emtestam L et al. Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol 2003; 149: 211-213
• 9 Bahmer F, Drosner M, Hohenleutner U et al. Empfehlung zur Behandlungen mit Laser und hochenergetischen Blitzlampen (HBL) in der Dermatologie. JDDG 2007; 5: 1036-1043
• 10 Fitzsimmons JS, Guilbert PR, Fitzsimmons EM. Evidence of genetic factors in hidradenitis suppurativa. Br J Dermatol 1985; 113: 1-8
• 11 Hurley H. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa and familial benign pemphigus. Surgical approach. In: Roenigk R, Roenigk H, eds. Dermatologic Surgery, Principles and Practice. New York, NY: Marcel Dekker; 1989
• 12 Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol 1998; 39: 971-974
• 13 Mendonca CO, Griffiths CEM. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol 2006; 154: 977-978
• 14 Mortimer PS, Dawber RP, Gales MA et al. A double-blind controlled cross-over trial of cyproterone acetate in females with hidradenitis suppurativa. Br J Dermatol 1986; 115: 263-268
• 15 Farrell AM, Randall VA, Vafaee T et al. Finasteride as a therapy for hidradenitis suppurativa. Br J Dermatol 1999; 141: 1138-1139
• 16 Joseph MA, Jayaseelan E, Ganapathi B et al. Hidradenitis suppurativa treated with finasteride. J. Dermatol. Treat 2005; 16: 75-78
• 17 Lévesque H, Trivalle C, Manchon ND et al. Fulminant hepatitis due to cyproterone acetate. Lancet 1989; 1: 215-216
• 18 Boer J, van Gemert MJ. Long-term results of isotretinoin in the treatment of 68 patients with hidradenitis suppurativa. J Am Acad Dermatol 1999; 40: 73-76
• 19 Rose RF, Goodfield MJD, Clark SM. Treatment of recalcitrant hidradenitis suppurativa with oral ciclosporin. Clin Exp Dermatol 2006; 31: 154-155
• 20 Buckley DA, Rogers S. Cyclosporin-responsive hidradenitis suppurativa. J R Soc Med 1995; 88: 289P-290P
• 21 Fardet L, Dupuy A, Kerob D et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in 7 consecutive patients. J Am Acad Dermatol 2007; 56: 624-628
• 22 Giamarellos-Bourboulis EJ, Pelekanou E, Antonopoulou A et al. An open-label phase II study of the safety and efficacy of etanercept for the therapy of hidradenitis suppurativa. Br J Dermatol 2008; 158: 567-572
• 23 Strober BE, Kim C, Siu K. Efalizumab for the treatment of refractory hidradenitis suppurativa. J Am Acad Dermatol 2007; 57: 1090-1091
• 24 Weyandt G. Operative Therapie der Acne inversa. Hautarzt Z Für Dermatol Venerol Verwandte Geb 2005; 56: 1033-1039
• 25 Mandal A, Watson J. Experience with different treatment modules in hidradenitis suppuritiva: a study of 106 cases. Surg J R Coll Surg Edinb Irel 2005; 3: 23-26
• 26 Tanaka A, Hatoko M, Tada H et al. Experience with surgical treatment of hidradenitis suppurativa. Ann Plast Surg 2001; 47: 636-642
• 27 Ritz JP, Runkel N, Haier J et al. Extent of surgery and recurrence rate of hidradenitis suppurativa. Int J Colorectal Dis 1998; 13: 164-168
• 28 Rompel R, Petres J. Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2000; 26: 638-643
• 29 Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. Br J Surg 1990; 77: 123-132
• 30 Menzel T, Dörner A, Cramer J. Exzision und offene Wundbehandlung des Sinus pilonidalis. Rezidivrate und Dauer der Arbeitsunfähigkeit. Dtsch Med Wochenschr 1997; 122: 1447-1451
• 31 Da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum 2000; 43: 1146-1156
• 32 McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev Online 2007; 4 CD006213
• 33 Badawy E, Kanawati M. Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Ldots 2009; 883-886
• 34 Stephens FO, Stephens RB. Pilonidal sinus: management objectives. Aust N Z J Surg 1995; 65: 558-560
• 35 Schulze SM, Patel N, Hertzog D et al. Treatment of pilonidal disease with laser epilation. Am Surg 2006; 72: 534-537
• 36 Stelzner F. Die Ursache des Pilonidalsinus und der Pyodermia fistulans sinifica. Langenbecks Arch Für Chir 1984; 362: 105-118
• 37 Dahl HD, Henrich MH. Licht- und rasterelektronenmikroskopische Untersuchungen zur Pathogenese des Sinus pilonidalis und der Analfistel. Langenbecks Arch Für Chir 1992; 377: 118-124
• 38 Al-Khayat H, Al-Khayat H, Sadeq A et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 2007; 205: 439-444
• 39 Popeskou S, Christoforidis D, Ruffieux C et al. Wound infection after excision and primary midline closure for pilonidal disease: risk factor analysis to improve patient selection. World J Surg 2011; 35: 206-211
• 40 Benedetto AV, Lewis AT. Pilonidal sinus disease treated by depilation using an 800 nm diode laser and review of the literature. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2005; 31: 587-591
• 41 Al-Hassan HK, Francis IM, Neglén P. Primary closure or secondary granulation after excision of pilonidal sinus?. Acta Chir Scand 1990; 156: 695-699
• 42 Kronborg O, Christensen K, Zimmermann-Nielsen C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 1985; 72: 303-304
• 43 Sondenaa K, Nesvik I, Andersen E et al. Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial. Eur J Surg Acta Chir 1996; 162: 237-240
• 44 Füzün M, Bakir H, Soylu M et al. Which technique for treatment of pilonidal sinus – open or closed?. Dis Colon Rectum 1994; 37: 1148-1150
• 45 Oram Y, Kahraman F, Karincaoğlu Y et al. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg Off Publ Am Soc Dermatol Surg. Al 2010; 36: 88-91
• 46 Grossman MC, Dierickx C, Farinelli W et al. Damage to hair follicles by normal-mode ruby laser pulses. J Am Acad Dermatol 1996; 35: 889-894
• 47 Finkelstein LH, Blatstein LM. Epilation of hair-bearing urethral grafts using the neodymium:YAG surgical laser. J Urol 1991; 146: 840-842
• 48 Gault DT, Grobbelaar AO, Grover R et al. The removal of unwanted hair using a ruby laser. Br J Plast Surg 1999; 52: 173-177
• 49 Liew SH, Grobbelaar AO, Gault DT et al. The effect of ruby laser light on ex vivo hair follicles: clinical implications. Ann Plast Surg 1999; 42: 249-254
• 50 Liew SH. Laser hair removal: guidelines for management. Am J Clin Dermatol 2002; 3: 107-115
• 51 Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220: 524-527
• 52 Haedersdal M, Wulf HC. Evidence-based review of hair removal using lasers and light sources. J Eur Acad Dermatol Venereol Jeadv 2006; 20: 9-20
• 53 Willey A, Torrontegui J, Azpiazu J et al. Hair stimulation following laser and intense pulsed light photo-epilation: review of 543 cases and ways to manage it. Lasers Surg Med 2007; 39: 297-301
• 54 Sadighha A, Mohaghegh Zahed G. Meta-analysis of hair removal laser trials. Lasers Med Sci 2009; 24: 21-25
• 55 Lin TY, Manuskiatti W, Dierickx CC et al. Hair growth cycle affects hair follicle destruction by ruby laser pulses. J Invest Dermatol 1998; 111: 107-113
• 56 Mandt N, Troilius A, Drosner M. Epilation today: physiology of the hair follicle and clinical photo-epilation. J Investig Dermatol Symp Proc Soc Investig Dermatol Inc Eur Soc Dermatol Res 2005; 10: 271-274
• 57 Dierickx C, Alora MB, Dover JS. A clinical overview of hair removal using lasers and light sources. Dermatol. Clin 1999; 17: 357-366, ix
• 58 Ibrahimi OA, Avram MM, Hanke CW et al. Laser hair removal. Dermatol Ther 2011; 24: 94-107
• 59 Nanni CA, Alster TS. A practical review of laser-assisted hair removal using the Q-switched Nd:YAG, long-pulsed ruby, and long-pulsed alexandrite lasers. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 1998; 24: 1399-1405 discussion 1405
• 60 Lou WW, Quintana AT, Geronemus RG et al. Prospective study of hair reduction by diode laser (800 nm) with long-term follow-up. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2000; 26: 428-432
• 61 Gold MH, Bell MW, Foster TD et al. Long-term epilation using the EpiLight broad band, intense pulsed light hair removal system. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 1997; 23: 909-913
• 62 Rao J, Goldman MP. Prospective, comparative evaluation of three laser systems used individually and in combination for axillary hair removal. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2005; 31: 1671-1676 discussion 1677
• 63 Kauvar AN. Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol 2000; 136: 1343-1346
• 64 Garcia-Zuazaga J. Pseudofolliculitis barbae: review and update on new treatment modalities. Mil Med 2003; 168: 561-564
• 65 Scheinfeld NS. A case of dissecting cellulitis and a review of the literature. Dermatol. Online J 2003; 9: 8
• 66 Weaver 3rd SM, Sagaral EC. Treatment of pseudofolliculitis barbae using the long-pulse Nd:YAG laser on skin types V and VI. Dermatol Surg Off Publ Am Soc Dermatol Surg. Al 2003; 29: 1187-1191
• 67 Petersen S, Wietelmann K, Evers T et al. Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 2009; 52: 131-134
• 68 Lapins J, Marcusson JA, Emtestam L. Surgical treatment of chronic hidradenitis suppurativa: CO2 laser stripping-secondary intention technique. Br J Dermatol 1994; 131: 551-556
• 69 Finley EM, Ratz JL. Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing. J Am Acad Dermatol 1996; 34: 465-469
• 70 Lapins J, Sartorius K, Emtestam L. Scanner-assisted carbon dioxide laser surgery: A retrospective follow-up study of patients with hidradenitis suppurativa. J Am Acad Dermatol 2002; 47: 280-285
• 71 Madan V, Hindle E, Hussain W et al. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol 2008; 159: 1309-1314
• 72 Hazen PG, Hazen BP. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg 2010; 36: 208-213
• 73 Sherman AI, Reid R. CO2 laser for suppurative hidradenitis of the vulva. J Reprod Med 1991; 36: 113-117
• 74 Bratschi HU, Altermatt HJ, Dreher E. Die Therapie der Hidradenitis suppurativa mit dem C02-Laser. Kasuistik und Literaturübersicht. Schweiz Rundsch Für Med Prax Rev Suisse Médecine Prax 1993; 82: 941-945
• 75 Dalrymple JC, Monaghan JM. Treatment of hidradenitis suppurativa with the carbon dioxide laser. Br J Surg 1987; 74: 420
• 76 Chegin VM, Skobelkin OK, Brekhov EI. Laser surgery for soft tissue purulent diseases. Lasers Surg. Med 1984; 4: 279-282
• 77 Klin B, Heller ON, Kaplan I. The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 1990; 8: 31-37
• 78 Tierney E, Mahmoud BH, Hexsel C et al. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminium garnet laser. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2009; 35: 1188-1198
• 79 Mahmoud BH, Tierney E, Hexsel CL et al. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol 2010; 62: 637-645
• 80 Xu LY, Wright DR, Mahmoud BH et al. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm Nd:YAG laser treatment. Arch Dermatol 2011; 147: 21-28
• 81 Jain V, Jain A. Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus. J Cutan Aesthetic Surg 2012; 5: 190-192
• 82 Sartorius K, Emtestam L, Jemec GBE et al. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol 2009; 161: 831-839
• 83 Downs A. Smoothbeam laser treatment may help improve hidradenitis suppurativa but not Hailey-Hailey disease. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol 2004; 6: 163-164
• 84 Highton L, Chan W-Y, Khwaja N et al. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg 2011; 128: 459-465
• 85 Odili J, Gault D. Laser depilation of the natal cleft – an aid to healing the pilonidal sinus. Ann R Coll Surg Engl 2002; 84: 29-32
• 86 Downs AMR, Palmer J. Laser hair removal for recurrent pilonidal sinus disease. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol 2002; 4: 91
• 87 Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthetic Surg Jpras 2008; 61: 1069-1072
• 88 Abbas O, Sidani M, Rubeiz N et al. Letter: 755-nm Alexandrite laser epilation as an adjuvant and primary treatment for pilonidal sinus disease. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2010; 36: 430-432
• 89 Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthetic Surg 2011; 4: 192-195
• 90 Landa N, Aller O, Landa-Gundin N et al. Successful treatment of recurrent pilonidal sinus with laser epilation. Dermatol Surg Off Publ Am Soc Dermatol Surg Al 2005; 31: 726-728
• 91 Lindholt CS, Lindholt JS, Lindholt J. Nd-YAG laser treatment in a patient with complicated pilonidal cysts. Bmj Case Reports Internet 2009; Published online 2009
• 92 Yeo MS-W, Shim TW-H, Cheong WK et al. Simultaneous laser depilation and perforator-based fasciocutaneous limberg flap for pilonidal sinus reconstruction. J Plast Reconstr Aesthetic Surg Jpras 2010; 63: e798-800
• 93 Lindholt-Jensen CS, Lindholt JS, Beyer M et al. Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 2012; 27: 505-508
• 94 Lavelle M, Jafri Z, Town G. Recurrent pilonidal sinus treated with epilation using a ruby laser. J Cosmet Laser Ther Off Publ Eur Soc Laser Dermatol 2002; 4: 45-47
• 95 Sadick NS, Yee-Levin J. Laser and light treatments for pilonidal cysts. Cutis Cutan Med Pr 2006; 78: 125-128