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Efficacy and safety of radiofrequency in the treatment of hidradenitis suppurativa; a systematic review

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Abstract

Background and aims

Hidradenitis suppurativa (HS) is an inflammatory skin disease affecting apocrine gland-bearing sites of the body. Radiofrequency (RF) is a minimally invasive method that acts by minimizing thermal damage to the dermis, resulting in collagen synthesis and scar improvement. We systematically reviewed the efficacy and safety of RF in treating HS.

Methods

A systematic search was performed up to November 18th, 2023, in PubMed/Medline, Ovid Embase, and Web of Science. Clinical studies with English full texts were included. The National Institute of Health (NIH) Quality Assessment Tool for clinical trials and Methodological quality and synthesis of case series and case reports by Murad et al. were utilized for critical appraisal.

Results

Out of 55 identified studies, 11 met our inclusion criteria with 167 subjects who underwent RF therapy alone or combined with an intense pulsed laser (IPL), known as LAight®. LAight® significantly improved clinical outcomes in mild-to-moderate HS patients based on the Dermatology Life Quality Index (DLQI), International Hidradenitis Suppurativa Score System (IHS4), Pain-Numerical Rating Scale (NRS), and Hidradenitis Suppurativa Clinical Response (HiSCR). Moreover, RF therapy alone significantly alleviated the clinical manifestations in patients with mild-to-moderate HS. Additionally, fractional microneedling RF significantly decreased HS-associated inflammatory markers. RF was found to be safe with limited adverse events. However, in moderate-to-severe HS, RF has failed to yield satisfactory results.

Conclusion

RF is a safe energy-based method with promising outcomes, especially for long-term application in mild-to-moderate HS. In moderate-to-severe cases, RF should be combined with a systemic medication for further beneficial impacts.

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Data availability

All relevant data are within the manuscript and its supplementary files.

Abbreviations

DLQI :

Dermatology Life Quality Index

ECM :

Extracellular matrix

HADS :

Hospital Anxiety and Depression Scale

HiSCR :

Hidradenitis suppurativa Clinical Response

HS :

Hidradenitis suppurativa

ICAM-1 :

Intercellular adhesion molecule-1

IFNγ :

Interferon gamma

IHS4 :

International Hidradenitis Suppurativa Score System

IL :

Interleukin

IPL :

Intense pulsed light

MMP :

Matrix metalloproteinase

NRS :

Numerical Rating Scale

PGA :

Physician Global Assessment

RF :

Radiofrequency

Th :

T helper

TNF-α :

Tumor necrose factor- alpha

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Acknowledgements

Not declared.

Funding

No external funding was received for this research.

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Authors and Affiliations

  1. Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran

    Mohammad Ali Nilforoushzadeh, Nazila Heidari, Amirhossein Heidari, Yekta Ghane, Seyedayin Hosseini, Zahra Lotfi, Fariba Jaffary, Zahra Sadat Aghamiri & Niloufar Najar Nobari

  2. Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Ali Nilforoushzadeh, Nazila Heidari, Amirhossein Heidari, Yekta Ghane, Fariba Jaffary & Niloufar Najar Nobari

  3. School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Nazila Heidari & Zahra Sadat Aghamiri

  4. Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

    Amirhossein Heidari

  5. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Yekta Ghane

  6. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Seyedayin Hosseini

  7. Department of Orofacial Pain and Dysfunction, UCLA School of Dentistry, Los Angeles, CA, USA

    Minou Najar Nobari

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  1. Mohammad Ali Nilforoushzadeh
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Contributions

Equal contributions to the current study are MaN and NH in the design, conceptualization, and revision of the final version of the manuscript. AH and YG in the database search, screening publications, data extraction, literature review, and manuscript drafting. SaH and ZL in data extraction and revising the final version of the manuscript. FJ, MnN, and ZsA are critically revising the final version of the manuscript. NnN in design, supervision, and revising the manuscript critically for the importance of intellectual content. All authors have read and approved the final version to be published and agreed to be accountable for all aspects of the work. All authors agreed on the order in which their names are listed in the manuscript.

Corresponding author

Correspondence to Niloufar Najar Nobari.

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Mohammad Ali Nilforoushzadeh and Nazila Heidari contributed equally to this work and shared the first authorship.

Highlights

• Hidradenitis suppurativa (HS) is a burdensome, multifactorial, complex disease with unclear pathogenesis and limited effective treatments.

• Radiofrequency (RF) is an energy-based treatment method that decreases inflammatory mediators and stimulates collagen synthesis following minimal thermal injury.

• RF alone or in combination with an intense pulsed laser has been suggested as a potential, safe treatment option for patients with mild-to-moderate HS.

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Nilforoushzadeh, M., Heidari, N., Heidari, A. et al. Efficacy and safety of radiofrequency in the treatment of hidradenitis suppurativa; a systematic review. Lasers Med Sci 39, 139 (2024). https://doi.org/10.1007/s10103-024-04077-0

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