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SAVANNAH, Georgia — The use of a carbon dioxide (CO₂) laser may be a promising treatment option for excision of inflammatory lesions in patients with severe hidradenitis suppurative (HS), new research suggested.

Results from a retrospective chart review of seven adults with severe HS who underwent a total of 11 CO₂ laser procedures to excise affected areas of axillary, thigh, or inframammary regions showed that recurrences were low, with most of the treated areas showing no active disease during a follow-up of 1.8-9.9 months. Only mild recurrences occurred after three of the procedures.

Additionally, postoperative pain scores were zero for all but one patient, who reported discomfort related to shoulder movement and not from the incision itself. There were no reports of wound-related adverse events, functional deficits, or major postoperative complications.

“This large wound did an excellent job of healing itself, and all you see is a fine line” after the procedure, study investigator Jared S. Kahn, MD, a third-year dermatology resident at Northwell Health, New York City, told Medscape Medical News.

“For a patient who has been walking around with draining tunnels and scarring, it transforms their life,” Kahn added.

He reported the findings at the American Society for Laser Medicine and Surgery (ASLMS) 2026 Annual Meeting.

Better Treatments Needed

Severe HS is characterized by extensive scarring and interconnected abscesses and sinus tracts. In moderate-to-severe forms of the disease, “conservative and targeted therapies” are often not effective for symptom control, the investigators noted in an abstract.

“We’ve come a long way in terms of the management of hidradenitis suppurativa from a medical standpoint, but this really only brings us so far. To get patients incrementally better, there is indication for surgery,” Kahn told meeting attendees.

However, there is currently not much information on what procedures offer the best postoperative outcomes, he said, adding that most research on these issues have been mostly case reports. “There is a gap in the research evidence,” Kahn said.

CO₂ laser therapy has the advantage of providing ambulatory-based surgery with local anesthesia. “We’re hoping for more outcome data so potentially, down the road, this could be something that insurers would view as coverable and that patients need as medical necessity,” Kahn noted.

The current study included six men and one woman aged 17-64 years with Hurley stage III HS (severe). All underwent excision with a CO₂ laser with a.2 mm spot size plus marsupialization. Surgical sites were the right and left axilla for three patients, the left axilla for two, the right and left inframammary region for one, and the left thigh for one — 11 procedures in total.

Outcomes included postoperative pain scores, recurrence, and complications/adverse events. Time to complete healing, defined as “full re-epithelialization without drainage or open sinus,” was also assessed. Recurrence was defined as the occurrence within or adjacent to the surgical site of new inflammatory nodules, tunnels, or abscesses.

Expected Healing Patterns

Results showed that time to complete healing ranged from 3-6 months for the six procedures that reported data on this outcome. “Overall healing patterns aligned with what was expected with secondary-intention closure following large-area excisional procedures,” Kahn said.

Postoperative pain scores were zero for 9 of the 10 procedures that had reports of pain. A score of 8 out of 10 due to pain associated with shoulder movement was reported by a patient who underwent laser treatment in the right axilla — but he reported zero pain after undergoing the procedure in the left axilla.

Among all 11 procedures, there were no recurrences in eight. The three cases of recurrence were described as mild.

“The benefit of using the CO₂ laser for HS is multifactorial and really lies with the hemostasis both postoperatively and intra-operatively. The ability to use precise margins to excise in HS is great with this laser,” Kahn said.

“There’s some thought that heating the tissue in the wound base may allow for reduced recurrence rates and the ablative nature of the laser can actually reduce residual areas of involvement as well,” he added.

Overall, this process may be an “effective and well-tolerated approach for patients also optimized on medical therapies,” Kahn noted.

Although the study was limited by its small number of participants and variable range of follow-up, he said that prospective studies in the future that assess standardized outcomes “may inform best practices and refine integration into procedural care pathways.” He noted that a multicenter, prospective study evaluating excision outcomes with CO₂ laser treatment, such as infection and recurrence rates is being initiated.

High-Level Procedure

Session moderator Chris W Robb, MD, PhD, co-founder of the Skin Allergy Center, Tennessee, told Medscape Medical News that while the technique is not new, what is new is the demonstration of efficacy and the value of CO₂ laser treatment in preventing recurrence of HS.

“I was most impressed with that as well as the safety profile of the procedure. These patients really suffer with a terrible condition that affects their quality of life,” said Robb, who was not involved with the research.

Also commenting on the study, E. Victor Ross, MD, director of the Scripps Clinic Laser and Cosmetic Dermatology Center, San Diego, complimented the presentation of the data, but noted that most dermatologists probably do not perform this procedure for HS because of its more surgical nature.

That said, Ross said that he has used a CO₂ laser for HS in his own practice, although “not so much” recently. “It’s a good tool and I think he showed that it can be done rather effortlessly and with little bleeding. The issue is allowing the wound to heal on its own, which is why it works — you don’t want to close these wounds,” Ross said.

During the 1-3 months it takes for the wounds to heal up, “it isn’t so painful” for the patient, but the wound discharge needs to be managed including the use of a lot of gauze, he noted. A “critical” element is that “you really have to be trained to use that continuous wave laser because there’s no recipe. You can’t go to the panel and just put in ‘HS settings.’ It’s a high-level procedure,” Ross said.

Still, he noted that although biologics have shown efficacy for HS, using them as a monotherapy doesn’t treat the source of the disease. “Unless you can get to the real core of the disease, it’s going to be persistent,” he added.

Ross also noted that the patients in the study had severe HS, “and at that point, you almost have to do some sort of surgery.”

Kahn, Robb, and Ross reported having no relevant financial relationships.