OBJECTIVES: To evaluate the safety, tolerability, and early clinical and ultrasound effects of a 1726-nm laser for hidradenitis suppurativa (HS) tunnels in a pediatric patient with skin of color. MATERIALS AND METHODS: A 16-year-old female (Fitzpatrick skin type VI) with moderate HS and bilateral axillary draining tunnels underwent 4 monthly treatments with a 1726-nm laser (22-24 J/cm²) directed only to the right axillary tunnel. The patient was receiving concurrent adalimumab therapy throughout the treatment period. Outcomes included investigator-rated Vancouver Scar Scale (VSS), patient-reported drainage, flare frequency, and pain (0-10 visual analog scale), as well as standardized photography and high-frequency ultrasound imaging performed at baseline and through week 15.5. RESULTS: By week 15.5, VSS of the treated right axilla improved from 9 to 2, primarily reflecting improved scar pliability (4 to 1). Drainage of the treated tunnel resolved after the first laser session and did not recur. In contrast, the untreated left axillary tunnel remained chronically draining. Ultrasound imaging of the treated side demonstrated a reduction in tunnel dimensions over time. Treatment was well tolerated, with a mean pulse-associated pain score of 3/10 that resolved immediately post-procedure, and no adverse events were observed. CONCLUSION: Treatment with a 1726-nm laser was associated with early resolution of drainage, improved scar pliability, and reduced tunnel dimensions on ultrasound. Although interpretation is limited by concurrent biologic therapy, the early unilateral response supports a localized laser effect. Larger controlled studies with longer follow-up are warranted to clarify the role of 1726-nm laser therapy in the management of HS tunnels.
Dreifus et al. (Mon,) studied this question.