Significant Quality of Life Gains Seen After CO₂ Laser Therapy for HS

In the largest prospective study of its kind, researchers at Aarhus University Hospital in Denmark evaluated the clinical outcomes and patient-reported quality of life following CO₂ laser treatment in patients with hidradenitis suppurativa (HS).¹

“HS is known for its fluctuations in disease activity, which can complicate the assessment of treatment effects,” the study authors wrote. “Despite the small sample size and these fluctuations, we observed significant improvements in both the DLQI and the HiSQOL scores 12 weeks post-operation.”

Background

The chronic nature of HS significantly impairs patients’ quality of life and makes treatment challenging. Although biologic therapies such as TNF-alfa and IL-17 inhibitors have shown promise, localized surgical approaches remain essential in cases of persistent or recurrent lesions.

Localized CO₂ laser treatment has been used for years in HS management, particularly in patients with stationary or recurrent abscesses, nodules, fistulas, or secretions at the same location^.2 However, robust prospective data on its efficacy and safety have been limited. This study aimed to evaluate patient-reported outcomes, complication rates, and recurrence following CO₂ laser therapy.

Methods & Materials

This prospective cohort study involved 52 HS patients undergoing CO₂ laser treatment for a single lesion at a tertiary dermatology center between September 2022 and September 2023. Approximately 75% of the participants were women. The mean age was 41 years. All Hurley stages were represented (19% with stage 1, 52% with stage 2, and 29% with stage 3).

Preoperative assessments were followed by structured phone interviews at 2, 6, and 12 weeks post-treatment. A standardized Dermatology Life Quality Index (DLQI) and Hidradenitis Suppurativa Quality of Life (HiSQOL) questionnaire was given to assess quality of life changes over time. Excision with a precision-cutting CO₂ laser was performed under local anesthesia. Deroofing was utilized if tunnels surrounding the treated area were present. Furthermore, the wound was intentionally left open with no suturing and protected with standard wound care and bandages until healed.

Results

A significant improvement in quality of life was observed in the full cohort. Mean DLQI decreased from 10.4 at baseline to 6.9 at follow-up (ΔDLQI = 3.5, p < 0.002) while mean HiSQOL dropped from 21.2 to 13.9 (ΔHiSQOL = 7.1, p < 0.006). There was a temporary dip in quality of life at week 2, but this was to be expected due to the post-procedural discomfort. The median sick leave post-treatment was 4.5 days, though 5 patients required more than 30 days.

Complications

Overall, complication rates were low, but the investigators did note some significant nuances. Approximately 27% of patients experienced prolonged wound healing (> 12 weeks), making it the most prevalent complication. Those with axillary wounds were twice as likely to experience delayed healing, but the size of the wound did not seem to correlate with prolonged wound healing. The second most prevalent complication was moderate to severe postoperative bleeding, occurring in 21% of participants and mostly in the groin area.

Three patients experienced infections post-operation, but none occurred in patients receiving biologics or antibiotics. Sensory disturbances were rare and cosmetic dissatisfaction was reported by only 4% of patients. HS recurrence at the edge of the treated area did occur in 26.9% of patients, mostly in those with Hurley stage 3 disease and those who smoked. Recurrence was more common in the axilla (43.8%) and genital regions (50%) than in the groin (24%). This rate is similar to what was found in previous research.

Conclusion

Overall, CO₂ laser therapy, performed under local anesthesia, is a safe and effective intervention for localized HS lesions, with significant improvements in patient-reported quality of life and acceptable complication rates. This study sets a new benchmark in prospective CO₂ laser research in HS and supports its integration into multimodal HS management strategies.

Larger randomized controlled trials with longer follow-up are needed to validate these findings, refine patient selection, and optimize procedural techniques, including the use of preoperative ultrasound, to further reduce recurrence and complications.

References

1. Daugaard, C.A., Schøsler, L.W., Rasmussen, M.K., Kibsgaard, L., Meszes, A., Høgsberg, T. Bertelsen, T. (2025), Largest Prospective Study of CO2 Laser Treatment in Hidradenitis Suppurativa Patients Showing Improved Quality of Life. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.70110

2. Scuderi N, Monfrecola A, Dessy LA, Fabbrocini G, Megna M, Monfrecola G. Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review. Skin Appendage Disord. 2017;3(2):95-110. doi:10.1159/000462979