Theoretically depilation could offer some relief to patients with HS. Previously X-ray therapy has been used to treat HS [7, 8]. The dosage varied, but often successful therapy induced depilation of the treated areas. Earlier papers on the topic have suggested that the positive effects were due as much to depilation as to the anti-inflammatory effects of the treatment (Chap. 23).
Such an effect may be hypothesized from the histology of the early lesions. An element of fol-licular occlusion is found in early lesions, and although pharmacological treatment with reti-noids, for example, has been disappointing in most cases, the physical removal of an obstructing hair shaft may prove even better at draining the follicle. Furthermore, free hair fragments may on occasion be found in lesions, suggesting that they may help to maintain the lesions by acting as foreign objects and evoking a chronic inflammatory response with, among others, multinucleated giant cells . Removal of hairs may therefore not only aid drainage, but also remove the necessary seeds for perpetuation of established lesions.
Depilation has however traditionally been suspected as a possible causative factor in HS, but the pattern of use of cosmetic procedures in the areas predisposed to HS does not appear to be different in patients and healthy controls [10, 11]. Furthermore, many patients with HS have never used depilatories in the areas where lesions occur. This makes it unlikely that any depilatory procedure forms a significant etiological factor in the development of HS.
In general, laser depilation has been shown to be a useful technique for hirsute patients, apparently using any of several types of available lasers. The absorption of laser light in the hair follicle induces transition to a telogen phase, and apparently shortens subsequent anagen phases of the follicle, consequently resulting in the growth of a shorter and thinner hair shaft .
Several unpublished cases among the authors of this book appear to substantiate this claim, although the success rate and duration of any beneficial effect are not known. Some patients apparently experience long-lasting remission, whereas others only have shorter periods of relief. Based on the available information, laser depilation nevertheless appears to be a promising area for further studies.
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