Hidradenitis suppurativa (HS) is a severe, chronic cutaneous disease characterized by painful nodules, abscesses, and sinus tracts in intertriginous areas.1Offidani A. Molinelli E. Sechi A. et al.Hidradenitis suppurativa in a prepubertal case series: a call for specific guidelines.J Eur Acad Dermatol Venereol. 2019; 33: 28-31Crossref PubMed Scopus (17) Google Scholar Laser treatment for hair removal has emerged as a valid therapeutic approach for HS. The long-pulsed neodymium-doped yttrium aluminum garnet laser has the highest number of case reports and controlled trials in all Hurley stage HS, and it is recommended in patients with Hurley stage II-III disease with the same level of evidence (level II) as wide excision.2Lyons A.B. Townsend S.M. Turk D. Narla S. Baah N. Hamzavi I.H. Laser and light-based treatment modalities for the management of hidradenitis suppurativa.Am J Clin Dermatol. 2020; 21: 237-243Crossref PubMed Scopus (5) Google Scholar Our study prospectively investigated the efficacy of alexandrite hair removal laser 755 nm as adjuvant treatment in mild to moderate HS. Forty female patients with HS (Hurley stage I-II) were evaluated. Twenty patients received a total of 5 laser treatments at 6-week intervals. Ten women were treated in the inguinal area, whereas 10 women were treated both in the inguinal area and axillae. Alexandrite laser parameters were set as follows: spot size, 20 mm; frequency, 5 Hz; fluence, 7 J/cm2, and energy delivered during the treatment (10 × 15 surface area) sets, 4500 to 4800 J. The clinical endpoints after laser radiation were perifollicular erythema and edema. The control group included 20 patients who did not receive any laser treatment. The attribution of patients to the laser group rather than the control group was made based on alternate assignment (nonrandomized study). All the patients (treated group and control group) were concomitantly treated with antiseptic chlorhexidine washes and oral gluconate zinc 90 mg daily for 30 weeks and were evaluated at baseline and at 15 and 30 weeks (Table I).Table ICharacteristic of patients (treated group and control group)FactorsTreated group n (%)Control group n (%)Sex Female2020 Male--Average age29.6 ± 10.431.5 ± 9.1Average BMI27.1 ± 3.126.6 ± 2.9Smokers7 (35)6 (30)Age of onset23.1 ± 6.224.7 ± 7.7Disease duration (years)4.1 ± 3.44.4 ± 2.9Family history6 (30)6 (30)Comorbidities Acne7 (35)5 (25) Pilonidal cyst2 (10)1 (5) PCOS1 (5)1 (5) Diabetes1 (5)0 Crohn disease1 (5)0No comorbidities10 (50)12 (60)Hurley stage I5 (25)6 (30) II15 (75)14 (70)IHS4 Mild6 (30)7 (35) Moderate14 (70)13 (75)SOS-HS I4 (20)5 (25) II16 (80)15 (75)BMI, Body mass index; IHS4, International Hidradenitis Suppurativa Severity Score System; PCOS, polycystic ovary syndrome; SOS-HS, Sonographic Scoring of Hidradenitis Suppurativa. Open table in a new tab BMI, Body mass index; IHS4, International Hidradenitis Suppurativa Severity Score System; PCOS, polycystic ovary syndrome; SOS-HS, Sonographic Scoring of Hidradenitis Suppurativa. Hidradenitis Suppurativa Clinical Response was achieved in 10 (50%) and 14 (70%) of laser-treated patients and in 2 (10%) and 4 (20%) of control group patients at 15 and 30 weeks, respectively (P < .001). Patients of the treated group correspondingly reported a marked reduction in pain (visual analog scale), Dermatology Life Quality Index and International Hidradenitis Suppurativa Severity Score System scores both at 15 and 30 weeks (P < .005). Moreover, a reduction in acute flares and a significantly longer disease-free survival in the treated and control groups (26.4 ± 6.6 weeks vs 12.3 ± 2.1 weeks) was observed. None of the patients experienced adverse events (Table II).Table IIPatients' disease characteristics at baseline and at weeks 15 and 30 (treated and control group; mean ± SD)Disease score and parametersTreated groupControl groupP valueP valueT0T15T30T0T15T30Treated vs control group T15Treated vs control group T30IHS46.5 ± 2.55.0 ± 2.14.9 ± 1.06.3 ± 2.65.9 ± 2.55.5 ± 2.4.001∗t test for continuous variables were used to assess statistical significance, with a P value < .005..001∗t test for continuous variables were used to assess statistical significance, with a P value < .005.Pain VAS5.2 ± 3.92.0 ± 2.12.4 ± 1.94.1 ± 4.74.5 ± 3.43.9 ± 4.1.002∗t test for continuous variables were used to assess statistical significance, with a P value < .005..002∗t test for continuous variables were used to assess statistical significance, with a P value < .005.DLQI15.4 ± 7.38.1 ± 1.84.5 ± 2.016.0 ± 4.113.4 ± 5.312.7 ± 7.7.002∗t test for continuous variables were used to assess statistical significance, with a P value < .005..001∗t test for continuous variables were used to assess statistical significance, with a P value < .005.Acute flare (n)-1.1 ± 0.32.1 ± 0.5-5.8 ± 2.26.4 ± 2.4.001∗t test for continuous variables were used to assess statistical significance, with a P value < .005..002∗t test for continuous variables were used to assess statistical significance, with a P value < .005.Duration of acute flare (days)-3.3 ± 1.73.1 ± 2.6-6.1 ± 2.85.4 ± 1.5.002∗t test for continuous variables were used to assess statistical significance, with a P value < .005..001∗t test for continuous variables were used to assess statistical significance, with a P value < .005.Disease-free survival (weeks)-26.4 ± 6.6-12.3 ± 2.1.001∗t test for continuous variables were used to assess statistical significance, with a P value < .005.DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; VAS, visual analog scale.∗ t test for continuous variables were used to assess statistical significance, with a P value < .005. Open table in a new tab DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; VAS, visual analog scale. HS is a disorder of the terminal follicular epithelium, with follicular occlusion acting as the inciting event in HS pathogenesis.3Chan J.Y. Long-pulsed alexandrite laser for treatment of hidradenitis suppurativa.J Am Acad Dermatol. 2013; 68: 224Google Scholar,4Hamzavi I.H. Griffith J.L. Riyaz F. Hessam S. Bechara F.G. Laser and light-based treatment options for hidradenitis suppurativa.J Am Acad Dermatol. 2015; 73: S78-S81Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Hair removal laser, which targets hair shafts and damages the bulge stem cell and dermal papilla of the follicle, has been described in the literature as a helpful treatment for HS.4Hamzavi I.H. Griffith J.L. Riyaz F. Hessam S. Bechara F.G. Laser and light-based treatment options for hidradenitis suppurativa.J Am Acad Dermatol. 2015; 73: S78-S81Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar,5Pratsou P. Koch D. Szczecinska W. Mcmullin H. Varma K. Abdullah A. The diverse application of laser hair removal: experience from a single laser unit.Br J Dermatol. 2012; 167: 94-95Crossref PubMed Scopus (41) Google Scholar Few case reports have been published on the beneficial use of alexandrite laser in HS.2Lyons A.B. Townsend S.M. Turk D. Narla S. Baah N. Hamzavi I.H. Laser and light-based treatment modalities for the management of hidradenitis suppurativa.Am J Clin Dermatol. 2020; 21: 237-243Crossref PubMed Scopus (5) Google Scholar,3Chan J.Y. Long-pulsed alexandrite laser for treatment of hidradenitis suppurativa.J Am Acad Dermatol. 2013; 68: 224Google Scholar Alexandrite 755 nm laser is characterized by adequate tissue penetration and greater affinity for melanin than the long-pulsed neodymium-doped yttrium aluminum garnet laser, leading to a more effective hair removal treatment.3Chan J.Y. Long-pulsed alexandrite laser for treatment of hidradenitis suppurativa.J Am Acad Dermatol. 2013; 68: 224Google Scholar Our study indicates that combining alexandrite laser with oral zinc may confer an even greater therapeutic benefit in HS, decreasing the disease severity and acute flare. The strengths of the study are based on its prospective and case-control design, whereas the main limitations are the small sample size and the absence of randomization. This study suggests that hair removal with alexandrite laser, particularly in conjunction with other medical approaches, could be a valuable option for the treatment of HS. 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