Hidradenitis Laser Treatment

Two in-office laser procedures for hidradenitis — one for the disease that is still inflammatory, one for the tunnels it has already left behind. No skin incision and no open wound to pack.

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Draft — pending Dr. Kamrava's review. Some details on this page are authored from cited sources and awaiting clinical sign-off.

Setting: In office
Anesthesia: None for follicle sessions; local anesthetic for tunnel closure
Back to work: Same day after follicle laser; desk work the next day after tunnel closure
Pain relief: Over-the-counter analgesics are usually sufficient
Follicle laser course: 4–6 sessions, 4–6 weeks apart
Tunnel closure: Single office visit

What it is

Two in-office laser procedures for hidradenitis suppurativa, matched to the two things the disease actually is. **Follicle-directed therapy (long-pulsed 1064 nm Nd:YAG)** reduces the population of hair follicles in an affected region. Hidradenitis begins at the follicle — the opening occludes, the follicle ruptures into surrounding tissue, and the immune response produces the nodule you feel. Fewer functional follicles means fewer events that can flare. The 1064 nm wavelength is chosen because it reaches follicles in thicker intertriginous skin and carries the lowest pigmentary risk across darker Fitzpatrick skin types. **Intralesional tunnel closure (1470 nm)** treats the structural half. A sinus tract is not inflamed tissue — it is a channel lined with skin-like cells, which is why antibiotics and biologics do not close it. A thin radial fibre is passed into each accessible tract through an opening it already has and withdrawn slowly while treating the lining, so the tract collapses and closes. No skin incision, no excision, no open wound. In the perianal and perineal region this matters structurally rather than aspirationally: nothing is removed from around the sphincter. It is the same technique used in this practice's pilonidal laser program, applied to hidradenitis tracts. Both sit between medical therapy and excisional surgery on the treatment ladder. Neither replaces dermatology-led care, and patients who stop their biologic around a procedure tend to do worse.

Am I a candidate?

**Hurley stage I** — isolated nodules and abscesses without established tracts. The primary indication for follicle-directed therapy, and the population the published literature supports most strongly. **Hurley stage II, selected** — used when active inflammation is the dominant feature, when tracts are limited, or in sequence with tunnel closure. Some patients have a short course of follicle therapy first to quiet the field around the area to be treated. **Established, accessible sinus tracts** — the indication for intralesional closure, in any region where the tracts can be entered through an opening they already have. **Perianal, perineal and gluteal disease especially.** The anatomy here is dense — sphincter, anal canal, gluteal cleft — and any plan has to protect continence. Distinguishing hidradenitis from pilonidal disease, cryptoglandular fistula and Crohn's perianal disease changes the plan entirely, and all of them can coexist with it. **Not suited to:** extensive confluent Hurley III disease without identifiable tract architecture, which may need a staged excisional approach with a reconstructive team; patients whose medical regimen has not yet had a fair turn, where dermatology should lead first; active infection in the planned field, where treatment is deferred until it resolves; and anyone looking for a one-time cure, because the model is sequenced and assumes ongoing medical co-management.

How it's done

1Consultation and mapping — the diagnosis is confirmed and the disease mapped: which regions are involved, which tracts are accessible, and what has already been tried. Disease is documented photographically to set the baseline that response is later measured against. Perianal planning is built around protecting continence.
2Follicle-directed sessions (1064 nm) — a long-pulsed Nd:YAG is delivered to the affected regions to reduce the follicular population driving inflammation. Each visit is a brief exam, photographic documentation, 20–45 minutes of treatment depending on area, and written aftercare. Topical cooling and short-acting numbing if it helps; no general anesthesia, and you drive yourself home.
3Reassessment at session four — the course is formally reviewed. Some patients are on track and finish; some move to maintenance sessions; some move on to tunnel closure.
4Tunnel closure (1470 nm intralesional) — under local anesthetic, a thin radial fibre is passed into each accessible tract through an opening it already has, then withdrawn slowly while treating the lining, so the tract collapses and closes. No skin incision, no excision, and no tissue removed from around the sphincter.
5Home the same day — a pressure dressing for 24–48 hours after tunnel closure, and no open wound to pack.

What to expect

Day 0
Walk out the same day. Some discomfort at injection sites; treated tracts may feel mildly tender. Pressure dressing stays on 24–48 hours.
Day 1
Most people return to desk work. Driving and travel are fine. Over-the-counter analgesics are usually enough.
Days 2–7
Normal daily activity with minimal restriction. No dressing changes beyond the first 24–48 hours.
Weeks 2–5
Treated tracts close progressively. Reported medians in the medical literature — other centres' results, not ours — put closure at around five weeks.
Weeks 4–6
Follow-up in the office or by video to assess closure and schedule any further sessions.
3–6 months
For the follicle-laser course, full benefit is judged three to six months after the course completes. Most people notice a change by the second or third session.

Risks & considerations

Hidradenitis is chronic, and no current treatment — medical, laser or surgical — is a cure. Tunnel closure addresses tracts that have already formed; it does not change the underlying inflammatory drive. New disease can arise in adjacent untreated follicles, which is common in hidradenitis and is why the inflammatory field is treated rather than tracts alone. Expect tenderness at local-anesthetic injection sites. Pigmentary change is possible at injection or surface-opening sites, more so in darker skin types — one reason the 1064 nm wavelength is used. Bleeding and infection are low with a closed-wound technique but are named because every procedure carries them. If a treated tract has not adequately healed within six months, further sessions on it are provided at no charge.

The risks that matter

Every operation carries a long list of possible complications. These are the ones that are serious enough — and common enough — to understand in real numbers before you decide.

It is not a cure for hidradenitis

Tunnel closure addresses tracts that have already formed. It does not change the underlying inflammatory drive, which remains a chronic medical question managed with your dermatologist.

If it happens: Medical therapy continues in parallel, and follicle-directed sessions target the inflammation that produces new structural disease.