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carbon dioxide &#40;CO<span class="elsevierStyleInf">2</span>&#41;&#44; alexandrite&#44; and diode laser therapies have also been used to treat HS&#46; The aim of these treatments is to reduce the number of hair follicles in areas where HS lesions tend to develop&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This systematic review aimed to update our understanding of the efficacy and safety of the various modalities of light-based therapy applied in HS&#46; We considered both conventional PDT and intralesional and laser treatments&#46; However&#44; we did not compare them&#44; given that their mechanisms of action differ and publications are few&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Literature Search Strategy</span><p id="par0035" class="elsevierStylePara elsevierViewall">We searched for articles on light-based therapies used alone or with a photosensitizer &#40;PDT&#41; to treat HS&#46; Articles had to be published between August 2015 and March 1&#44; 2019&#46; Additional limiters were set to select studies in humans that were published in either Spanish or English&#46; We started the search with August 2015 because a systematic review in the Cochrane Library was updated at that time&#46; Our intention was to update that review with the results of more recent studies&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We also searched backwards from the reference lists to identify any cited articles meeting our inclusion criteria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following databases were used&#58; MEDLINE &#40;through PubMed&#41;&#44; EMBASE&#44; the Centre of Reviews and Dissemination &#40;University of York&#41;&#44; the Cochrane Library &#40;in the Cochrane Database of Systematic Reviews&#41;&#44; the Cochrane Skin Group&#44; the Centre of Evidence Based Dermatology &#40;University of Nottingham&#41;&#44; and TESEO &#40;the Andalusian database of PhD theses&#41;&#46; The following trial registries were also consulted&#58; ClinicalTrials&#46;gov&#44; reec&#46;aemps&#46;es&#44; and Clinicaltrialsregister&#46;eu&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally&#44; the PROSPERO register was searched for systematic reviews on HS&#46; We specified reviews that included light-based therapies&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Search terms were chosen from the list of Medical Subject Headings &#40;English&#41; and its equivalent in Spanish &#40;Descriptores en Ciencias de la Salud&#41;&#44; as follows&#58; photochemotherapy&#44; photodynamic therapy&#44; hidradenitis suppurativa&#44; suppurative hidradenitis&#44; light&#44; lasers&#44; laser therapy&#44; intense pulsed light therapy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Article inclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Type of study&#58; randomized controlled clinical trials &#40;RCTs&#41;&#44; systematic reviews&#44; observational studies with a control group&#44; and observational studies without a control group &#40;case series&#41;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Population&#58; adults with HS regardless of sex&#44; ethnicity&#44; comorbidity&#44; or prior treatment</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Limiter&#58; inclusion of patients whose HS was treated with PDT &#40;using any type of laser or other light source&#41;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Limiter&#58; publication in Spanish or English</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">Article exclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Publication outside the time frame</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Studies not using accepted&#44; validated HS evaluation tools &#40;eg&#44; the Hidradenitis Suppurativa Clinical Response criterion&#44; the modified Sartorius score&#44; and&#47;or the Physician Global Assessment &#91;PGA&#93; of HS&#41;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Case series with fewer than 5 patients</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Editorials and narrative reviews</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Data Management&#44; Extraction and Synthesis&#44; and Analysis of Research Design Quality</span><p id="par0110" class="elsevierStylePara elsevierViewall">Search results were downloaded with Mendeley reference management software&#44; with titles and abstracts in separate fields&#46; All duplicate&#44; discarded&#44; and selected references were recorded &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The literature searchers were not blinded to authors&#8217; names or institution or the publishing journal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The scale of Jadad et al<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> was used to evaluate RCTs&#46; Critical analysis was based on the CONSORT guidelines &#40;Consolidated Standards for Reporting Clinical Trials&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The tool of the Basque Office for Health Technology Assessment &#40;OSTEBA&#44; its Spanish acronym&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> was used to assess the quality of evidence afforded by several types of studies and build a table synthesizing the results&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Included and Excluded Studies</span><p id="par0120" class="elsevierStylePara elsevierViewall">Of the 199 studies found&#44; we excluded 164 after removing duplicates and assessing the titles and abstracts&#46; We evaluated 35 full texts&#44; excluding 24 that did not meet the inclusion criteria&#46; Some did not have 5 patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#44;16&#8211;37</span></a> &#40;See Appendix B&#44; supplementary material&#46;&#41; Because few clinical trials and systematic reviews were found&#44; we included case series even though their evaluation of efficacy and effectiveness is limited&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Thus&#44; we evaluated 6 case series &#40;5 prospective and 1 retrospective&#41;&#46; The evidence level was low in 4 of the series and moderate in 2 of them&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Most studies were carried out in Europe &#40;Spain&#44; the United Kingdom&#44; France&#44; and Italy&#41;&#44; the United States&#44; and Egypt&#46; The remaining inclusions were 2 moderate-quality RCTs and 3 high-quality systematic reviews&#46; The reviews included 4 trials and 5 case series on light-based treatments and are analyzed in depth in the present systematic review&#58; Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Calzavara-Pinton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Schweiger et al&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Sotiriou et al&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Mahmoud et al&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> and Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1&#8211;3</a> summarize the studies&#8217; periods of follow-up&#44; numbers of patients and losses&#44; population characteristics and interventions&#46; One relevant study<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> was found in a backward citation search of references&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Sample Size</span><p id="par0140" class="elsevierStylePara elsevierViewall">The number of participants in the included studies ranged widely&#46; The maximum was 38<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> and the minimum was 5&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;42</span></a> for a total of 248 patients &#40;mean&#44; 15&#46;5 patients&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Participants</span><p id="par0145" class="elsevierStylePara elsevierViewall">All the studies included men and women older than 18 years with a clinical diagnosis of HS&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">One study included only Hurley stage 1 patients &#40;Zerbinati et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a>&#41; and 1 included only Hurley stage 2 patients &#40;Mahmoud et al<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#41;&#46; Two studies included both Hurley 1 and 2 stages &#40;Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> and Fabbrocini et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a>&#41;&#46; Six studies required moderately severe HS &#40;Hurley stages 2 or 3&#41; at baseline &#40;Andino Navarrete et al&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Xu et al&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> and Sotiriou et al<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#41;&#46; One study included any stage of severity &#40;stages 1&#44; 2&#44; or 3&#41; &#40;Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a>&#41;&#46; Finally&#44; 5 studies did not specify stage &#40;Valladares-Narganes et al&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Calzavara-Pinton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> and Schweiger et al<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Study Designs</span><p id="par0155" class="elsevierStylePara elsevierViewall">We included 3 systematic reviews for this systematic update &#40;Ingram et al&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> John et al&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> and Robert et al<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#41; and 2 clinical trials &#40;Fadel and Tawfik<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> and Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a>&#41;&#46; The remaining studies were case series&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The systematic review of Ingram et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> included 3 RCTs comparing topical PDT&#44; IPL and Nd&#58;YAG laser therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;38&#44;39</span></a> Fadel and Tawfik<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> used an active comparator in the control group&#46; Controls were untreated in Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> whereas Tierney et al<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> applied 1&#37; clindamycin cream in the control group&#46; The systematic review of John et al<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> included 22 studies&#46; Three provided high-quality evidence &#40;and were also included by Ingram et al&#41;&#46; The only additional inclusion that met our criteria was that of Xu et al&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> which assessed Nd&#58;YAG laser treatment&#46; The most up-to-date systematic review was by Robert et al&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> who included 64 articles about the nonsurgical treatment of HS &#40;with medications or light therapies&#41;&#46; Studies of light-based treatments that were not included in the aforementioned reviews were those of Calzavara-Pinton et al<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> &#40;PDT with methyl aminolevulinate &#91;MAL&#93;&#41; and Schweiger et al<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> and Sotiriou et al<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> &#40;PDT with ALA&#41;&#46; This third systematic review also included two case series of patients treated with Nd&#58;YAG laser &#40;Mahmoud et al<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#41; and CO<span class="elsevierStyleInf">2</span> laser &#40;Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Only 2 RCTs were retrieved&#46; One was by Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> which was found by backwards searching of citations as described above&#46; The other was by Abdel Azim et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> which evaluated a combined treatment with CO<span class="elsevierStyleInf">2</span> laser followed by Nd&#58;YAG laser&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">One of the case series we included studied the use of PDT with 20&#37; ALA as the photosensitizer and 635-nm laser &#40;Andino Navarrete et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#41;&#46; Three studies analyzed intralesional PDT&#46; Two used ALA at concentrations of 5&#37; and 1&#37; and a 630-nm laser light source&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a> The third used MB and a 635-nm light-emitting diode &#40;LED&#41; lamp &#40;Aktilite&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Zerbinati et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> analyzed case series in which Nd&#58;YAG laser was used&#44; and Fabbrocini et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> evaluated the efficacy of diode laser irradiation in mild to moderate HS&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Outcome Measures</span><p id="par0180" class="elsevierStylePara elsevierViewall">The included studies assessed outcomes in somewhat different ways&#46; Most used the Sartorius score of 2003&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;11&#44;38</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;41&#8211;43&#44;45&#44;47&#44;49</span></a> but 2 studies used the modified version of this score&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a> Five &#40;Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Abdel Azim et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Calzavara-Pinton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Fabbrocini et al&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> and Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&#41; used the PGA&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Six evaluated changes in quality of life with the Dermatology Life Quality Index &#40;DLQI&#41; published by Finlay in 1994&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;41&#44;42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">49&#44;50</span></a> General satisfaction was evaluated by Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> with an unvalidated Likert scale and by Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> with a score of 0 &#40;very unsatisfied&#41; to 10 &#40;very satisfied&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Two studies assessed pain during and after treatment using a visual analog scale &#40;VAS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;51</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Four studies provided information about adverse effects&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;51</span></a> although Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> only reported such effects if treatment had to be interrupted&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Finally&#44; 5 studies reported recurrence rates&#46; Agut-Busquet et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> emphasized recurrence&#44; explaining each case&#46; Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> reported recurrence in 9 patients&#46; Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> found that HS tended to recur 12 months after treatment&#46; Recurrence 3 and 12 months after treatment was assessed by Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> and Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> respectively&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Outcomes Obtained With Light-Based Therapies</span><p id="par0205" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1&#8211;3</a> summarize the research designs used and quality of evidence obtained by researchers studying the use of conventional PDT&#44; intralesional PDT&#44; and laser treatments&#46; As explained above&#44; the 3 systematic reviews we consulted included patients treated with both PDT and laser therapy&#46; Therefore&#44; to avoid repetition&#44; one table &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; presents the studies that applied laser treatments and IPL in bold face type&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">PDT</span><p id="par0210" class="elsevierStylePara elsevierViewall">Andino Navarrete et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> treated 5 patients with a 20&#37; ALA solution for 1&#46;5<span class="elsevierStyleHsp" style=""></span>h and then irradiated the area with a 635-nm LED lamp at a fluence of 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> and intensity of 70<span class="elsevierStyleHsp" style=""></span>mW&#47;cm<span class="elsevierStyleSup">2</span> per session&#46; The patients experienced improvements &#40;Sartorius score&#44; DLQI&#44; and VAS&#41; that was maintained at 8 weeks&#44; although the differences were not statistically significant&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Fadel and Tawfik<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> used PDT with a 0&#46;01&#37; MB gel &#40;formulation in liposomes with surfactants to increase penetration&#41; and compared it to placebo &#40;MB-free&#41; gel&#46; The area was irradiated with IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#41; for 20<span class="elsevierStyleHsp" style=""></span>ms at a fluence of 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The participants were authorized to receive treatment at every affected area of the body &#40;armpits&#44; buttocks&#44; groin&#44; and under the breasts&#41;&#46; Results showed a Sartorius score reduction of 77&#46;3&#37; &#40;liposome MB gel formulation&#41; and 44&#46;1&#37; &#40;MB-free placebo&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; The authors concluded that PDT with MB in this formulation is superior to irradiation after MB-free gel&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Calzavara-Pinton et al<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> studied patients with various diseases treated with MAL-PDT&#59; 6 patients with HS were among them&#46; The authors irradiated with red light &#40;635<span class="elsevierStyleHsp" style=""></span>nm&#41; every 2 weeks for 4 weeks and reported a PGA assessment of more than 75&#37; in 33&#37; of the cases&#44; moderate improvement in half&#44; and a poor response in 1 patient&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Schweiger et al<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> described 12 patients treated with ALA-PDT with blue light and IPL weekly for 4 weeks&#46; Four weeks after treatment they observed a reduction in the Sartorius score of 50&#46;8&#37;&#46; At 8 weeks the reduction was 29&#46;9&#37;&#46; The DLQI score fell from 17&#46;3 to 13&#46;1&#46; Blue light was tolerated better than IPL&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Finally&#44; Sotiriou et al<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> applied a 20&#37; ALA formulation in 5 sessions in 5 patients with Hurley stage 2 or higher HS&#46; The mean Sartorius score decreased from 18&#46;8&#37; to 17&#46;2&#37;&#44; and DLQI impact fell 6&#46;4&#37; on average&#46; These results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Intralesional PDT</span><p id="par0235" class="elsevierStylePara elsevierViewall">Valladares-Narganes et al<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> administered 1&#37; ALA &#40;0&#46;2<span class="elsevierStyleHsp" style=""></span>mL&#47;cm<span class="elsevierStyleSup">3</span>&#41; into lesions followed by light exposure&#44; as noted above&#44; in a series of 27 patients with 1 to 3 lesions each&#46; After 26&#46;21 months &#40;range&#44; 21&#46;07&#8211;68&#46;57 months&#41;&#44; responses were complete in 10 patients &#40;37&#37;&#41;&#44; moderate in 11 &#40;41&#37;&#41;&#44; and partial in 5 &#40;19&#37;&#41;&#46; The authors saw the best results in armpit lesions &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Agut-Busquet et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> injected a 1&#37; MB solution into lesions under ultrasound guidance in 7 patients&#46; After incubation &#40;15<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#44; the lesions were irradiated with an LED lamp &#40;Aktilite&#44; 635<span class="elsevierStyleHsp" style=""></span>nm&#44; 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; After 6 months the global assessment of response was 78&#37; in 1 patient&#44; 80&#37; in 1&#44; 90&#37; in 2&#44; and 99&#37; in 2&#46; Patients with Hurley stage 2 HS responded better &#40;99&#37;&#41; than those with Hurley stage 3 &#40;87&#37;&#41;&#44; and the best results were observed in groin lesions&#46; DLQI improved significantly for 6 patients&#44; coinciding with excellent response to treatment&#46; Mild adverse effects &#40;swelling or erythema&#41; were observed in 6 patients &#40;86&#37;&#41;&#44; but they resolved within a week &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> injected a 5&#37; ALA gel into lesions through a cannula placed along the sinus tract in 38 patients&#46; After incubation under opaque occlusion for 2<span class="elsevierStyleHsp" style=""></span>hours&#44; intralesional laser irradiation &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 1&#46;2<span class="elsevierStyleHsp" style=""></span>W&#59; fluence&#44; 180<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; was applied with a fiberoptic probe &#40;400<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; All regions treated improved according to modified Sartorius scale results&#46; There were 53 complete responses&#44; 7 good responses&#44; and 4 partial responses&#46; However&#44; the differences were not statistically significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Nd&#58;YAG Laser Treatment</span><p id="par0250" class="elsevierStylePara elsevierViewall">Tierney et al<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> compared Nd&#58;YAG treatments with 10&#37; benzoyl peroxide and daily application of 1&#37; clindamycin versus application of the topical antibiotic alone&#46; Seventeen patients were enrolled and 4 laser sessions were given at intervals of 1 month &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The reduction in severity according to modified Sartorius assessment was 65&#46;3&#37; at 3 months on average over all regions &#40;73&#46;4&#37; in the groin&#44; 62&#37; in the armpits&#44; and 53&#46;1&#37; under the breasts&#41;&#46; Improvement was significant in laser-treated patients&#44; but not in the control group &#40;topical clindamycin only&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Xu et al<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> published a prospective&#44; controlled histopathologic study in 19 patients with Hurley stage 2 HS&#46; The patients were treated in 2 monthly sessions of Nd&#58;YAG laser therapy &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41;&#46; The percent response to treatment on the Sartorius score after 2 months was 31&#46;6&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Greater improvement was recorded in groin lesions &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Zerbinati et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> observed a mean improvement of 85&#46;3&#37; in the Sartorius score with Nd&#58;YAG treatment of very early Hurley stage 1 HS in 12 patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In a similar study&#44; but with 22 patients with more severe HS &#40;Hurley stage 2&#41;&#44; Mahmoud et al<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> evaluated the response at 6 months to 4 sessions of a series of 1 long-pulse Nd&#58;YAG treatment per month for 4 months&#46; They also observed a decrease in the Sartorius score &#40;&#8722;72&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Other Types of Laser Treatment</span><p id="par0265" class="elsevierStylePara elsevierViewall">An RCT of CO<span class="elsevierStyleInf">2</span> laser treatment was carried out by Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> in 20 patients over the age of 18 years who had Hurley stage 1 or 2 HS&#46; The aim was to assess the safety and efficacy of combining fractional CO<span class="elsevierStyleInf">2</span> irradiation with long-pulse Nd&#58;YAG laser irradiation &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in 4 sessions separated by 2 weeks&#46; On the intervention side the patients received fractional CO<span class="elsevierStyleInf">2</span> laser treatment followed by long-pulse Nd&#58;YAG laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in the same session&#46; On the control side&#44; only the Nd&#58;YAG treatment was used&#46; The authors concluded that improvement and satisfaction were greater with the combined treatment of early &#40;Hurley stage 1 and 2&#41; disease and that the recurrence rate was lower &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Of 9 patients with medically and surgically refractory HS who received CO<span class="elsevierStyleInf">2</span> laser treatments from Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> 7 had achieved complete remission at 12 months&#46; Satisfaction was high &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Finally&#44; Fabbrocini et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> used laser diode light in a group with Hurley stage 1 or 2 HS and mild to moderate disease according to PGA&#46; The patients received 4 sessions spaced every 2 weeks&#46; A significant reduction of 31&#37; was seen in the Sartorius scores&#44; which changed from 28&#46;55 &#40;SD&#44; 13&#46;04&#41; to 19&#46;75 &#40;SD&#44; 12&#46;29&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The authors also reported a direct association between improvement and better quality of life &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">IPL</span><p id="par0280" class="elsevierStylePara elsevierViewall">Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> enrolled 18 patients in an RCT comparing active and control treatments on contralateral sides&#46; The active treatment was IPL &#40;50<span class="elsevierStyleHsp" style=""></span>ms&#44; 420<span class="elsevierStyleHsp" style=""></span>nm&#44; fluence of 7&#8211;10<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; They observed a mean reduction in the Sartorius score of 12&#37; immediately after therapy&#44; 10&#37; at 3 to 6 months&#44; and 3&#37; at 12 months&#46; The difference between the treated and control sides was significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Patient satisfaction was high&#46; Response was complete in 1 case&#44; excellent in 2 cases&#44; good in 10&#44; and moderately good in 4&#46; Fifteen did not experience significant changes on the control side&#58; 1 patient reported slight improvement and another experienced slight worsening&#46; The treatment was applied once a week for 4 weeks&#46; Follow-up was 12 months &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0285" class="elsevierStylePara elsevierViewall">Considering the limited evidence available for light-based treatments for HS&#44; it is difficult to draw conclusions about the efficacy of either intralesional versus topical approaches&#44; or IPL or Nd&#58;YAG laser&#46; Variation in study designs makes comparison difficult&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">We identified 3 photosensitizers being used in PDT&#58; ALA&#44; MAL&#44; and MB&#46; All of them were applied at different concentrations from 1&#37; to 20&#37; for ALA&#44; 16&#37; for MAL&#44; and 0&#46;01&#37; to 1&#37; for MB&#46; Which concentration leads to a better response rate is difficult to establish because evaluation methods differ&#46; Moreover&#44; the type of light used to irradiate lesions also varies&#44; as some groups use LED lamps&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;40&#44;42</span></a> while others apply external<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or intralesional laser<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a> and still others use IPL&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;41</span></a> The possibility of treating deep HS lesions is an important factor in efficacy&#44; yet these light sources have frank differences in penetration&#46; The light doses also differ&#44; although the wavelength applied is similar at 630 or 635<span class="elsevierStyleHsp" style=""></span>nm&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">The studies also treated lesions at different sites&#44; for different durations and numbers of sessions &#40;from 1<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> to 12<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#41;&#46; The main difference in technique&#44; however was between the use of topical versus intralesional application of both the photosensitizer &#40;ALA&#44; MAL&#44; or MB&#41; and the light source &#40;LED&#44; laser&#44; or IPL&#41;&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">We found that intralesional treatment approaches also differed between authors&#46; Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> and Valladares-Narganes et al<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> used 630-nm diode lasers and ALA at different concentrations&#46; They assessed response with the modified Sartorius score&#44; finding that response was better with a 5&#37; ALA gel and a 400-nm diode laser &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>W and 180<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the other hand&#44; used a 1&#37; MB formulation and a 635-nm LED with a fluence of 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; They assessed efficacy with the DQLI and the Sartorius score&#44; reporting responses that varied from 99&#37; for cases involving Hurley stage 1 to 87&#37; in Hurley stage 3&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">The single study of IPL we found reported that statistically significant improvement was maintained for 12 months and that the risk of complications was low&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">The RCT of Nd&#58;YAG laser treatment by Tierney et al<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> demonstrated efficacy&#46; Later case series describing this treatment have reported reduction in the number of exacerbations and in severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;47</span></a> Efficacy has been reported to be greater in the groin&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">Very few studies have been published on other types of lasers&#44; but all of them report promising results&#46; The combination of CO<span class="elsevierStyleInf">2</span> and Nd&#58;YAG lasers obtained better results than Nd&#58;YAG irradiation alone and patient satisfaction was higher&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> showed that CO<span class="elsevierStyleInf">2</span> laser therapy and marsupialization also led to high rates of complete remission in spite of adverse effects&#44; such as hypertrophic scarring&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">We found a single study of diode laser therapy for HS that was considered mild to moderate according to the PGA&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> The authors reported clinical and quality-of-life improvement after therapy&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">In summary&#44; the evidence supporting the use of light-based therapies for HS is limited&#46; There are 2 major groupings of these therapies according to whether a photosensitizer is used or not&#46; In 1 group&#44; for which only a low-moderate level of evidence is available&#44; the authors applied Nd&#58;YAG laser&#44; CO<span class="elsevierStyleInf">2</span> laser&#44; or IPL&#46; In the other&#44; for which the quality of evidence is also low-moderate&#44; PDT &#40;with photosensitizer&#41; was used&#46; Thus&#44; all the treatments reviewed used light but they are not comparable&#58; different techniques have different mechanisms of action&#46; However&#44; results for individual treatments do seem to suggest that approaches that offer greater penetration &#8212; whether by means of intralesional application or lasers &#8212; lead to better results&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">RCTs are necessary to confirm the efficacy of these treatments&#46; We also need to see standardized research protocols applying the design that is most appropriate for providing stronger evidence for the efficacy and safety of each technique&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Authorship</span><p id="par0335" class="elsevierStylePara elsevierViewall">T&#46; Gracia Caza&#241;a and L&#46;V&#46; Berdel Garc&#237;a contributed equally to this article&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Hidradenitis supurativa"
            1 => "Terapia fotodin&#225;mica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Treatment options for hidradenitis suppurativa include light-based therapy&#46; This systematic review aimed to update our understanding of the efficacy&#44; effectiveness and safety of these treatments for hidradenitis suppurativa by evaluating the literature published since the 2015 Cochrane review on this topic&#46; We conducted an electronic search of the following databases&#58; MEDLINE&#44; EMBASE&#44; University of York Centre for Reviews and Dissemination database&#44; Cochrane Database of Systematic Reviews&#44; Cochrane Skin Group Specialised Skin Register&#44; University of Nottingham&#8217;s Centre of Evidence Based Dermatology database&#44; and TESEO&#46; The systematic review included 6 case series&#44; 3 systematic reviews&#44; and 2 clinical trials on the use of conventional and intralesional photodynamic therapy&#44; intense pulsed light therapy&#44; and Nd&#58;YAG&#44; carbon dioxide&#44; and diode laser therapy for hidradenitis suppurative in 248 patients&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La terapia con luz es una alternativa en el tratamiento de la hidradenitis supurativa &#40;HS&#41;&#46; El objetivo fue evaluar la eficacia&#44; efectividad y seguridad de las distintas modalidades de terapia con luz en la HS&#44; mediante una revisi&#243;n sistem&#225;tica actualizando la realizada en 2015 procedente de Cochrane Library&#46; Se identificaron los estudios mediante una b&#250;squeda electr&#243;nica en las bases de datos&#58; MEDLINE&#44; EMBASE&#44; Universidad de York&#44; Cochrane Database of Systematic Reviews&#44; Cochrane Skin Group&#44; Centre of Evidence based dermatology de la Universidad de Nottingham&#44; TESEO finalmente se incluyeron 6 series de casos y 3 revisiones sistem&#225;ticas y 2 ensayos cl&#237;nicos de pacientes tratados con terapia fotodin&#225;mica convencional o intralesional&#44; l&#225;ser Nd&#58;YAG&#44; CO2 o diodo y luz intensa pulsada&#44; con un total de 248 pacientes tratados&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Gracia Caza&#241;a T&#44; et al&#46; Revisi&#243;n sistem&#225;tica de las terapias con luz en el tratamiento de la hidrosadenitis supurativa&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;89&#8211;106&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the literature search for this systematic review&#46; TESEO is the database of doctoral theses in Andalusia&#44; Spain&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ALA&#44; 5-aminolevulinic acid&#59; CO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide&#59; DLQI&#44; Dermatology Life Quality Index&#59; HS&#44; hidradenitis suppurativa&#59; HS-LASI&#44; HS lesion&#44; area and severity index&#59; IPL&#44; intense pulsed light&#59; MAL&#44; methyl aminolevulinate&#59; MB&#44; methylene blue&#59; Nd&#58;YAG&#44; neodymium and neodymium&#58;yttrium aluminum garnet&#59; PDT&#44; photodynamic therapy&#59; QoL&#44; quality of life&#59; RCT&#44; randomized clinical trial&#59; VAS&#44; visual analog scale&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design&#44; Aim and Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention and Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of Evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Andino Navarrete et al&#44;<span class="elsevierStyleSup">2</span> 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To assess the efficacy &#40;Sartorius&#44; DLQI&#41; and safety of PDT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ALA and 635-nm light treatment of moderate to severe HS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 5<span class="elsevierStyleItalic">Characteristics&#58;</span> HS type 2 or Hurley stage 3&#59; 4 armpit lesions&#44; bilateral &#43; 1 pubic&#59;1 man&#44; 4 women&#59;Mean age&#44; 26<span class="elsevierStyleHsp" style=""></span>&#40;5&#41; y&#59; Mean time since onset&#44; 4<span class="elsevierStyleHsp" style=""></span>&#40;1&#41; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; ALA solution for 1&#46;5<span class="elsevierStyleHsp" style=""></span>h&#59; light &#40;635<span class="elsevierStyleHsp" style=""></span>nm&#44; 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 70<span class="elsevierStyleHsp" style=""></span>mW&#47;cm<span class="elsevierStyleSup">2</span>&#41; per sessionMinimum 4 sessions spaced 1&#8211;2 wk<span class="elsevierStyleItalic">Follow-up&#58;</span> 4 and 8 wk<span class="elsevierStyleItalic">Losses&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Significantly improved severity&#44; DLQI&#44; and VAS scores at 8 wkMean Sartorius decrease of 35<span class="elsevierStyleHsp" style=""></span>&#40;5&#41; to 18<span class="elsevierStyleHsp" style=""></span>&#40;8&#41; pointsDLQI decrease&#44; 21 points after 4 sessions&#44; sustained at 8 wkVAS pretreatment&#44; 3&#59; decrease &#40;0&#8211;1&#41; at 4 and 8 wk&#44; all patientsOnly adverse effect&#44; burning on irradiation &#40;2 patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment with topical 20&#37; ALA and 635-nm light could be effective for refractory HS&#44; decreasing severity and improving QoL&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small series&#44; limiting external validity and extrapolation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> single-blind RCT<span class="elsevierStyleItalic">Objectives&#58;</span> To assess the efficacy and safety of MB niosome gel as photosensitizer in IPL treatment of HS<span class="elsevierStyleItalic">Study period&#58;</span>6 mo &#40;month and year not specified&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 17&#44; intraindividual &#40;contralateral control&#41;&#59; 6 exclusions&#59; 11 cases analyzed&#46;<span class="elsevierStyleItalic">Characteristics&#58;</span> 7 women&#44; 4 men&#59; mean age 27&#46;1 y &#40;range&#44; 17&#8211;35 y&#41;&#46;Lesions&#58; both armpits &#40;4&#41;&#59; multiple gluteal &#40;3&#41;&#59; groin &#40;2&#41;&#59; under breasts &#40;1&#41;&#46;No topical or systemic treatment 2 weeks before enrollment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervention side&#58;</span> PDT with topical 0&#46;01&#37; MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#41; every 2 wk2 sessions&#47;mo up to 6 mo<span class="elsevierStyleItalic">Control side&#58;</span> PDT with placebo topical MB-free gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; every 2 wk<span class="elsevierStyleItalic">Follow-up&#58;</span> 1&#44; 3&#44; and 6 mo after treatments<span class="elsevierStyleItalic">Losses after randomization&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDT with topical 0&#46;01&#37; MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL was superior to placebo gel&#59; reduction of Sartorius score by 77&#46;3&#37; and 44&#46;1&#37;&#44; respectively&#46;Mean HS-LASI improvement was significant in both groups&#58; active treatment&#44; 77&#46;3&#37; &#40;18&#46;86&#37;&#41;&#59; vs placebo gel&#44; 44&#46;1&#37; &#40;28&#46;19&#37;&#41;Similar adverse effects &#40;pain&#44; erythema&#44; hyperpigmentation&#41;&#59; no effect of treatment site or disease stage<span class="elsevierStyleItalic">Adverse effects&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#41; with this photosensitizer &#40;MB&#41; is effective&#46; MB in niosome formulation enhances dermal penetration&#46;Hair follicle destruction was also attributed to 630-nm &#955; ray&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited by small sample size and short follow-up period&#46; Intraindividual RCTs with more patients and longer follow-up are needed&#46; RCTs with comparators &#40;medical and surgical treatments&#41; are also needed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ingram et al&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> systematic review of RCTs<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the effects of interventions for HS in persons of any age<span class="elsevierStyleItalic">Period searched&#58;</span> 1983&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any person &#40;any sex&#44; age&#44; or ethnicity&#41; with a clinical diagnosis of HS made by a physician and based on a standard definition of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions&#58;</span> More than 40 interventions for HS were included&#44; though evidence was lacking for many&#46; Interventions grouped as pharmacologic&#44; surgical&#44; and other&#46; 3 trials&#58;<span class="elsevierStyleItalic">Fadel and Tawfik&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleItalic">2015</span>Intervention 1&#58; PDT with topical 0&#46;01&#37; MG gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; every 2 wkIntervention 2&#58; PDT with placebo gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; every 2 wk&#44;2 sessions&#47;mo up to 6 mo<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Highton et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2011</span></span><span class="elsevierStyleBold">randomized sides&#44; 1 untreated control side and 1 treated with IPL&#44; twice weekly for 4 wk &#40;420<span class="elsevierStyleHsp" style=""></span>nm&#44; 7&#8211;10<span class="elsevierStyleHsp" style=""></span>J&#47;cm</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleBold">a 50<span class="elsevierStyleHsp" style=""></span>ms&#41;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Tierney et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2009</span></span><span class="elsevierStyleBold">Left and right sides of the same anatomical structure received 1 of the following treatments&#58;</span><span class="elsevierStyleBold">- 10&#37; benzoyl peroxide wash and</span> 1&#37; <span class="elsevierStyleBold">clindamycin in gel or lotion &#40;frequency not indicated&#41;&#46;</span><span class="elsevierStyleBold">- 4 Nd&#58;YAG laser treatments monthly and topical</span> 10&#37; <span class="elsevierStyleBold">benzoyl peroxide and</span> 1&#37; <span class="elsevierStyleBold">clindamycin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of studies and patients&#58;</span> 12 trials with 615 patients Median&#44; 27 participants&#59; mean duration of treatment&#44; 16 wk&#46; Included studies were done between 1983 and 2015&#46;<span class="elsevierStyleItalic">Effect size&#58;</span> The 3 trials of laser or other light-based treatments were judged to offer a low level of evidence because of lack of precision and adequate blinding&#46;<span class="elsevierStyleItalic">Fadel and Tawfik&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleItalic">2015</span>PDT with topical 0&#46;01&#37; MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL was superior to placebo MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL&#59; Sartorius score fell by 77&#46;3&#37; and 44&#46;1&#37;&#44; respectively<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Highton et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2011</span></span><span class="elsevierStyleBold">Significant benefit from IPL in 18 patients&#58; mean Sartorius score reduction of</span> 12&#37; <span class="elsevierStyleBold">immediately after therapy&#44;</span> 10&#37; <span class="elsevierStyleBold">at 3 months&#44;</span> 10&#37; <span class="elsevierStyleBold">at 6 months&#44; and</span> 3&#37; <span class="elsevierStyleBold">at 12 months&#46; No comparator&#46; Patients assessed satisfaction on an unvalidated Likert scale&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Tierney et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2009</span></span><span class="elsevierStyleBold">17 patients&#44; 4 Nd&#58; YAG laser treatments at monthly intervals on 1 side of the body in 25 regions with lesions&#46; Significantly improved Sartorius scores in treated armpits&#46; A 6</span>5&#46;3&#37; <span class="elsevierStyleBold">reduction in HS severity at 3 mo overall&#46; By locations&#58; 7</span>3&#46;4&#37; <span class="elsevierStyleBold">groin&#44;</span> 62&#37; <span class="elsevierStyleBold">armpits&#44; 5</span>3&#46;1&#37; <span class="elsevierStyleBold">under breasts&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Studies of Nd&#58;YAG laser&#44; IPL&#44; and topical PDT treatments were of poor quality because of lack of blinding and absence of placebo comparison&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">John et al&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> systematic review of RCTs and nonrandomized trials&#44; other systematic reviews&#44; case&#8211;control cohort studies&#44; case series&#44; and expert opinion<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the effects of laser treatment of HS in persons of all ages<span class="elsevierStyleItalic">Period searched&#58;</span> 1987&#8211;April 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any individual regardless of sex&#44; age&#44; or ethnicity with a diagnosis of HS treated by any type of laser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions&#58;</span> 47 studies found&#59; 22 analyzed after applying inclusion and exclusion criteriaTwo studies provided grade A evidence &#40;Jadad scale&#41; and 1 provided grade B evidence&#46;Laser therapy was assessed in 3 studies&#58;Higher quality evidence &#40;grade A&#44; Jadad&#41; from Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> both included in the systematic review of Ingram et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> &#40;above&#41;&#46;<span class="elsevierStyleBold">Xu et al</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleBold">provided grade B evidence &#40;Jadad&#41;&#46;</span><span class="elsevierStyleBold">19 patients with Hurley stage 2 HS treated with long-wave Nd&#58;YAG laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; twice monthly</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of studies and patients&#58;</span> 22 studies&#44; 2 with grade A evidence&#44; 1 with grade B&#44; and the rest with grade C &#40;very low&#41;In total&#44; 59 patients were treated in grade A or B studies&#46; The included studies were done between 1987 and 2016&#46;<span class="elsevierStyleItalic">Effect size&#58;</span> grade A evidence assigned to the trials of Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> as explained in the entry for the inclusions of the systematic review of Ingram et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Xu et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2011</span>&#44; grade B&#46; The percent change in Sartorius score after 2 mo of treatment was 31&#46;6&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; on average for all lesion sites&#59; 24&#46;4&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; for armpits and 36&#46;8&#37; for groin &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; But on histology 3 patients still had inflammation&#44; and the percent changes were not clinically significant&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The conclusion was that there was moderate support for the efficacy long-pulse Nd&#58;YAG laser and IPL in HS and for reducing recurrence by means of hair follicle destruction&#59; and limited evidence for CO<span class="elsevierStyleInf">2</span> laser<span class="elsevierStyleInf">&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Large RCTs&#44; preferably multicenter ones&#44; are needed to standardize assessment techniques and assess efficacy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Robert et al&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> systematic review of RCTs and nonrandomized trials&#44; other systematic reviews&#44; case&#8211;control cohort studies&#44; case series&#44; and expert opinion<span class="elsevierStyleItalic">Objective&#58;</span> To summarize and analyze research on current nonsurgical techniques for treating HS<span class="elsevierStyleItalic">Period searched&#58;</span> January 2005&#8211;September 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Included&#58;</span> all original research articles on nonsurgical HS treatments &#40;RCTs&#44; prospective or retrospective observational studies&#44; and case series of at least 4 patients&#41;<span class="elsevierStyleItalic">Excluded&#58;</span> single case studies&#44; narrative reviews&#44; discussions&#44; opinion articles&#44; research letters&#44; and editorials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions&#58;</span> 64 included articles&#46; Evidence level generally low&#59; most were retrospective observational studies&#46;Biological treatments &#40;44&#37;&#41;&#44; PDT or other phototherapies &#40;16&#37;&#41;&#44; antibiotic therapy &#40;11&#37;&#41;&#44; laser &#40;8&#37;&#41;&#44; retinoids &#40;6&#37;&#41;&#44; and other immunosuppressant therapies&#46;10 articles on PDT&#58; 4 have already been mentioned elsewhere in our review &#40;Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Valladares-Narganes et al&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> Andino Navarrete et al&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41;&#46; After applying our inclusion and exclusion criteria&#44; we evaluated the following&#58;<span class="elsevierStyleItalic">Calzavara-Pinton et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">2013</span>&#44; treated 6 patients &#40;no Hurley stage reported&#41; with MAL-PTD &#40;red light&#44; 635<span class="elsevierStyleHsp" style=""></span>nm&#41; every 2 wk for 4 wk<span class="elsevierStyleItalic">Schweiger et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleItalic">2011</span>&#44; treated 12 patients with ALA-PTD &#40;IPL or blue light&#41;&#44; weekly for 4 wk<span class="elsevierStyleItalic">Sotiriou et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleItalic">2009</span>&#44; treated 5 patients &#40;Hurley stage 2 or higher with 20&#37; ALA and red light &#40;570&#8211;670<span class="elsevierStyleHsp" style=""></span>nm&#41; 3<span class="elsevierStyleHsp" style=""></span>h later&#59; 4 sessions at 15-d intervals&#59; assessment with VAS&#44; Sartorius score and DLQI<span class="elsevierStyleBold">Laser was used in 5 studies&#46; We excluded 2 reports of &#60;5 patients or with nonvalidated assessment tools and Mikkelsen et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleBold">a retrospective series that was not relevant &#40;only evaluating long-term recurrence after CO<span class="elsevierStyleInf">2</span> laser&#41;&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Mahmoud et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2010</span>&#44; treated 22 patients &#40;Hurley stage 2&#41; with 4 sessions of long-pulse Nd&#58;YAG laser monthly for 4 mo&#59; follow-up&#44; 6 mo&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Madan et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2008</span>&#44; treated 9 medically and surgically refractory cases of HS with CO<span class="elsevierStyleInf">2</span> &#40;1 session&#44; follow-up at 12 mo&#41;&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of studies&#44; patients and effect sizes&#58;</span><span class="elsevierStyleItalic">Calzavara-Pinton et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">2013</span>&#44; assessed response by PGA&#46; Response was &#62;75&#37; in 33&#37; of patients&#44; moderate in half&#44; and &#60;50&#37; in 1&#46;<span class="elsevierStyleItalic">Schweiger et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleItalic">2011</span>&#44; saw a Sartorius score reduction of 50&#46;8&#37; at 4 wk and 29&#46;9&#37; at 8 wk&#46; Mean DLQI scores were 17&#46;3 at baseline and 13&#46;1 at 4 wk&#46; Tolerance was better with blue light than IPL&#46;<span class="elsevierStyleItalic">Sotiriou et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleItalic">2009</span>&#44; reported that mean Sartorius scores went from 18&#46;8 at baseline to 17&#46;2 on treated sides at the first follow-up visit&#46; Mean VAS evaluations of disease activity&#47;pain went from 2&#46;4 to 2&#46;1&#46; DLQI scores fell by 6&#46;4&#37;&#46;<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Mahmoud et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2010&#44;</span> measured the effect of Nd&#58;YAG laser in 22 patients with the Sartorius score&#44; reporting a 72&#37; reduction&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Madan et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2008&#44;</span> reported the PGA of the effect&#59; 7 out of 9 patients had complete remission and expressed high satisfaction&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No nonsurgical treatment leads to long-term remission&#46; The authorsemphasized the need for surgery in refractory and debilitating cases&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low quality of evidence&#46; Heterogeneous methods of assessment&#44; scarcely comparable&#46; Few RCTs&#59; most studies are of retrospective cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Means are shown with the SD in parentheses&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Bold face indicates articles obtained from systematic reviews in which light-based therapies other than PDT were used&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summary of Studies Included in Systematic Reviews That Used PDT Alone or in Combination With Surgery to Treat HS<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a></p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BMI&#44; body mass index&#59; DLQI&#44; Dermatology Life Quality Index&#59; E&#44; energy &#59; HS&#44; hidradenitis suppurativa&#59; HSS&#44; hidradenitis severity score&#59; IR&#44; irradiation&#59; MB&#44; methylene blue&#59; PDT&#44; photodynamic therapy&#59; PGA&#44; Physician&#8217;s Global Assessment&#59; RCT&#44; randomized clinical trial&#59; VAS&#44; visual analog scale&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design&#44; Aim and Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention and Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valladares-Narganes et al&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To apply PDT with intralesional light probes that can reach different depths with light at the lowest energy level possible<span class="elsevierStyleItalic">Study period&#58;</span> March&#8211;November 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span>27 &#40;single group&#41;<span class="elsevierStyleItalic">Characteristics&#58;</span><elsevierMultimedia ident="202004140650279201"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional 1&#37; ALA solution &#40;dose&#44; 0&#46;2<span class="elsevierStyleHsp" style=""></span>mL&#47;cm<span class="elsevierStyleSup">3</span>&#41;&#46;By cannula inserted into fistulous tracts&#44; or needle injection into the diseased area if cannulation was impossible&#46;The entrance to and exit from the fistula was covered for an incubation period of 3<span class="elsevierStyleHsp" style=""></span>h&#46; Next&#44; the fistula was irradiated intralesionally with a continuous diode laser &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; fiberoptic probe 1<span class="elsevierStyleHsp" style=""></span>mm in diameter&#59; 1<span class="elsevierStyleHsp" style=""></span>W&#47;cm<span class="elsevierStyleSup">3</span>&#59; 180<span class="elsevierStyleHsp" style=""></span>J&#41;&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; Light was transmitted through a 1-mm needle&#46;If response was suboptimal or new lesions appeared nearby&#44; an additional session was given&#46;<span class="elsevierStyleItalic">Follow-up&#58;</span> 1&#44; 3&#44; and 6 mo<span class="elsevierStyleItalic">Losses&#58;</span> 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Results on the modified Sartorius scale&#58; 10 &#40;37&#37;&#41; complete&#44; 11 &#40;41&#37;&#41; good&#44; and 5 &#40;19&#37;&#41; partial&#46;Best results in the armpits &#40;complete response in 6 of 8&#41;&#44; including patients requiring treatment of both armpits&#46;Moderate pain in 4 patients &#40;VAS&#44; 6&#8211;9&#41;Most patients &#40;22 of 27&#41; tolerated the procedure well &#40;VAS scores under 6&#41;&#46;Adverse effects included postprocedural pain&#44; erythema and slight swelling&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional PDT may be an effective and long-lasting treatment for HS&#46;The best results are in isolated lesions in the armpits or sacral and breast regions&#44; where most lesions are found&#46; Multiple&#44; interconnected fistulas require more sessions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCTs would be a good step toward adequate assessment of therapies alone or in combination&#46; Trials should include dose detection and patient-relevant outcome measures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> respective case series<span class="elsevierStyleItalic">Objective&#58;</span> To describe the experience with 7 patients with HS treated with PDT using intralesional MB and light &#40;635<span class="elsevierStyleHsp" style=""></span>nm&#41;<span class="elsevierStyleItalic">Study period&#58;</span> 8 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 7<span class="elsevierStyleItalic">Characteristics&#58;</span> HS clinical type 2&#44; Hurley stage 3&#44; at least 1 active zone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional 1&#37; MB solution injected with or without ultrasound guidance&#46;After incubation &#40;15<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; irradiation with a 635-nm LED light &#40;37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;1&#8211;2 sessions&#44; intervals of 15 d&#46;<span class="elsevierStyleItalic">Follow-up&#58;</span> 1&#44; 2&#44; 4&#44; and 6 mo<span class="elsevierStyleItalic">Losses&#58;</span> 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hurley stage-2 patients responded better than stage-3 patients &#40;99&#37; vs 87&#37; improvement&#41;&#59; best results in the groin&#46;DQLI improvement in 6 patients&#58; 78&#37; &#40;1&#41;&#44; 80&#37; &#40;1&#41;&#44; 90&#37; &#40;2&#41;&#44; and 99&#37; &#40;2&#41;&#46;Evaluation&#44; Sartorius score and PGA&#58; 78&#37; &#40;1 patient&#41;&#44; 80&#37; &#40;1&#41;&#44; 90&#37; &#40;2&#41;&#44; 99&#37; &#40;2&#41;&#46;Good response &#40;86&#37; improvement&#41; to antibiotic in only 1 patient&#46;<span class="elsevierStyleItalic">Adverse effects&#58;</span> mild in 6 cases &#40;86&#37;&#41;&#59; serious in 1 patient &#40;cellulitis at treatment site&#44; attributed to patient&#8217;s manipulation of the area after therapy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional PDT with MB gives good results in HS but is more effective in Hurley stage 2 than stage 3&#46;RCTs are necessary to improve the quality of evidence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Few patients&#44; making extrapolation to the general population &#40;external validation&#41; difficult&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Su&#225;rez Valladares et al&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the efficacy of intralesional PDT for the local management of HS in the short and medium term in different sites<span class="elsevierStyleItalic">Study period&#58;</span> March 2011&#8211;November 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 38<span class="elsevierStyleItalic">Characteristics&#58;</span>Sex&#58; 20 women&#44; 18 menAge&#58; 30&#8211;44 yWeight&#58; 67&#46;25&#8211;90<span class="elsevierStyleHsp" style=""></span>kgMean &#40;SD&#41; BMI&#58; 26&#46;87 &#40;4&#46;89&#41;BMI &#62;27&#58; 20Smokers&#58; 34Prior treatments&#58; 2&#44; none&#59; 1&#44; topical&#59; 23&#44; oral antibiotics&#59; 2&#44; oral retinoids&#59; 1&#44; biologic&#59; 9&#44; surgery&#46;Hurley stages&#58; 1&#44; 4 patients&#59; 2&#44; 21 patients&#59; 3&#44; 13 patients&#46;Direct measures of severity&#58; Hurley&#44; baseline&#47;total HSS&#44; and DLQI indicated high disease activity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After local anesthesia&#44; 5&#37; ALA gel was injected through a cannula to fill the fistulous tracts&#46; Thus&#44; all walls of fistulous tracts were treated regardless of depth&#46; A lyophilized 1&#37; solution was injected into nodules&#46; Incubation under occlusion for 2<span class="elsevierStyleHsp" style=""></span>h before irradiation&#46; Irradiation &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>W&#59; fluence&#44; 180<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; with an intralesional 630-nm laser through a 400-mm fiberoptic probe inserted through a needle&#46;Follow-up visits every 5&#8211;7 wk<span class="elsevierStyleItalic">Follow-up&#58;</span> 26&#46;1 &#40;21&#46;7&#8211;68&#46;57&#41; mo<span class="elsevierStyleItalic">Losses&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Single session regardless of site&#44; but the median energy used was greater in the armpits&#46;Complete remission in 76&#46;3&#37;&#44; mean disease-free period of 168 wk&#46; New lesions at untreated sites were observed in 9 patients &#40;23&#46;7&#37;&#41;&#59; 6 of them had complete remission&#46;Recurrence or no remission after treatment in 9 patients&#44; in whom the percentages of obesity &#40;33&#46;&#37; vs 58&#46;6&#37;&#41; and smoking &#40;66&#46;7 vs 96&#46;6&#37;&#41; were lower but disease severity was greater &#40;44&#46;4&#37; vs 31&#37;&#41;&#44; modified Sartorius score was higher &#40;36 vs 22&#41; and DLQI poorer &#40;16 vs 10&#41; than in those with a good response to PDT&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional PDT might offer a new alternative treatment for HS lesions&#44; alone or in combination&#59;a high rate of complete remission was achieved and was long-lasting&#46;No complications observed&#46;Rapid recovery after treatment&#44; with the possibility of repeating sessions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of Articles on Intralesional PDT for HS</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide&#59; DLQI&#44; Dermatology Life Quality Index&#59; HS&#44; hidradenitis suppurativa&#59; Nd&#58;YAG&#44; neodymium-doped yttrium aluminum garnet&#59; PGA&#44; Physician&#8217;s Global Assessment&#59; RCT&#44; randomized clinical trial&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design&#44; Aim and Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention and Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zerbinati et al&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the clinical and histologic effects of Nd&#58;YAG laser treatment of HS<span class="elsevierStyleItalic">Study period&#58;</span> not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 12<span class="elsevierStyleItalic">Characteristics&#58;</span> Hurley stage 1 HSMean age 39&#46;5 y &#40;range&#44; 24&#8211;50 y&#41;&#44; bilateral disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in 300&#8211;600-&#956;m polycarbonate-coated glass optical fiber&#59;fluence&#44; 300<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; Different fiber diameters were used according to lesion size and site&#46;Pulse energy&#44; 150&#8211;350<span class="elsevierStyleHsp" style=""></span>mJ&#44;3 laser sessions &#40;1 every 2 mo&#41;&#46;<span class="elsevierStyleItalic">Follow-up&#58;</span> 12 mo<span class="elsevierStyleItalic">Losses&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean percent Sartorius score improvement&#44; 85&#46;3&#37;&#46;Decrease in inflammatory infiltrate confirmed histologically&#59; fibrosis 4 mo posttreatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG laser is a well-tolerated&#44; noninvasive alternative treatment for this chronic&#44; debilitating disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">More patients should be followed for longer periods to provide stronger evidence for conclusions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG and CO<span class="elsevierStyleInf">2</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdel Azim et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> RCT&#44; intraindividual&#44; blinded<span class="elsevierStyleItalic">Objectives&#58;</span> To study the safety and efficacy of combined treatment with fractional CO<span class="elsevierStyleInf">2</span> and long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser for treating HS&#46;<span class="elsevierStyleItalic">Study period&#58;</span> January&#8211;December 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 20 &#40;30 enrolled&#44; 10 excluded&#41;<span class="elsevierStyleItalic">Characteristics&#58;</span> patients &#62;18 y with bilateral Hurley stage 1 or 2 lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervention&#58;</span> 4 laser sessions at 2-wk intervals&#46; Intervention-side treatment was combined fractional CO<span class="elsevierStyleInf">2</span> followed by long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser in the same session&#46;<span class="elsevierStyleItalic">Control&#58;</span> contralateral side&#44; long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser only<span class="elsevierStyleItalic">Follow-up&#58;</span> 3 mo after last session<span class="elsevierStyleItalic">Losses after randomization&#58;</span> 5 during follow-up to assess sustained response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Significant improvement and greater patient satisfaction for the combined treatment over the control treatment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;011 and &#46;048&#44; respectively&#41;&#46; PGA evaluation of response to treatment showed absence of recurrence in 55&#37; of the intervention sides &#40;combined treatment&#41; vs 35&#37; on the control sides&#46; Histology of the skin 2 wk after the last session revealed a scant perifollicular lymphohistiocytic infiltrate on the combined-treatment side&#46; Less decrease in the infiltrate and in dermal edema on the Nd&#58;YAG-only side&#46; No adverse effects other than erythema&#44; which resolved spontaneously by 48<span class="elsevierStyleHsp" style=""></span>h&#46;<span class="elsevierStyleItalic">Adverse effects&#58;</span> 1 patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Combined fractional CO<span class="elsevierStyleInf">2</span> and long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser therapy achieves greater improvement and patient satisfaction and lower recurrence rates in comparison with Nd&#58;YAG therapy alone for HS in Hurley stages 1 and 2&#46; Combined therapy could achieve better results in patients with low PGA scores who are not obese and have not undergone prior surgery at the site of a lesion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limitations&#44; a small sample size and short follow-up&#46; RCTs are needed to analyze intraindividual responses in more patients and for longer periods and to compare combined laser therapies to medical and surgical treatments of HS&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional diode laser</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fabbrocini et al&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the efficacy of intralesional 1064-nm diode laser treatments in mild-moderate HS&#46;<span class="elsevierStyleItalic">Study period&#58;</span> May 2016&#8211;January 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 20<span class="elsevierStyleItalic">Characteristics&#58;</span> patients with Hurley stage 1 or 2 HS&#44; mild-moderate according to PGA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Diode laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in 300&#8211;600<span class="elsevierStyleHsp" style=""></span>nm<span class="elsevierStyleHsp" style=""></span>polycarbonate-coated glass optical fiber&#46;Fluence&#44; 250<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; fiber diameters varied according to type of lesion and site&#46;Pulse energy&#44; 150&#8211;350<span class="elsevierStyleHsp" style=""></span>ms&#59; selected potency&#44; 6&#8211;8&#8211;10<span class="elsevierStyleHsp" style=""></span>W&#46; A 30-gauge needle was used to inject an anesthetic solution &#40;1<span class="elsevierStyleHsp" style=""></span>mL&#47;cm<span class="elsevierStyleSup">2</span>&#41; until tumescence&#46;On the day of treatments&#44; all patients started azithromycin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;d for 3 d&#41;&#46;4 treatment sessions&#44; 2-wk intervals&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Each patient underwent 4 laser sessions at 2-wk intervals&#46; Significant reduction &#40;31&#37;&#41; in the Sartorius score from 28&#46;55 &#40;13&#46;04&#41; to 19&#46;75 &#40;12&#46;29&#41; after 4 sessions &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; No patient worsened&#46;Quality of life improved notably along with clinical improvement &#40;reduction in DLQI scores &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0307&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional 1064-nm diode laser treatment may be a good alternative for patients with moderate&#44; localized HS&#44; given it is minimally invasive and does not have significant complications&#46; Recovery is rapid&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Few patients&#44; low quality of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Review
Systematic Review of Light-Based Treatments for Hidradenitis Suppurativa
Revisión sistemática de las terapias con luz en el tratamiento de la hidrodenitis supurativa
T. Gracia Cazañaa,
Corresponding author
tamgracaz@gmail.com

Corresponding author.
, L.V. Berdel Díazb,*, J.I. Martín Sánchezc, I. Querol Nasarreb, Y. Gilaberted
a Unidad de Dermatología, Hospital de Barbastro, Barbastro, Huesca, Spain
b Departamento de Medicina, Psiquiatría y Dermatología, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
c Decisiones Basadas en la Evidencia, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
d Servicio de Dermatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the literature search for this systematic review&#46; TESEO is the database of doctoral theses in Andalusia&#44; Spain&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hidradenitis suppurativa &#40;HS&#41; is a chronic&#44; debilitating inflammatory disease of hair follicles and their associated sebaceous glands&#46; HS usually appears after puberty&#46; Underlying the condition is immune dysregulation in a genetically predisposed individual&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The general population prevalence&#44; which ranges from 0&#46;1&#37; to 1&#37;&#44; is higher in the second and third decades of life and in women&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Smoking&#44; obesity&#44; hormonal imbalance&#44; and stress from friction or shaving can trigger or aggravate HS&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nodules&#44; abscesses&#44; suppurative fistulous tracts&#44; and scarring in skin folds &#40;mainly the armpits&#44; groin&#44; and anogenital regions&#41; are the most common presentations&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The main symptoms are pain&#44; burning or a local sensation of heat&#59; pruritus&#59; and hyperhidrosis&#46; These manifestations have a negative impact on quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The management of HS is complex and requires a multidisciplinary approach&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Light-based treatments have been used experimentally in recent years&#46; Photodynamic therapy &#40;PDT&#41; involves applying a photosensitizer that produces reactive oxygen species in a process that leads to cellular destruction&#46; The hypothesized benefit of PDT in HS is based on a direct cytotoxic effect on biofilm bacteria and sebaceous glands as well as on immunomodulation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> When a photosensitizer is applied topically to HS lesions&#44; accumulation occurs more easily than in normal skin because openings and fistulas facilitate penetration&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Lesions improve with light activation&#46; Light at a wavelength of 630<span class="elsevierStyleHsp" style=""></span>nm is sufficient for activating 5-aminolevulinic acid &#40;ALA&#41; and methylene blue &#40;MB&#41;&#44; which are 2 of the photosensitizers used&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Topical PDT has advantages that make it an attractive alternative therapy for treating multiple lesions simultaneously&#59; it is minimally invasive&#44; has few adverse effects&#44; and is well tolerated&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Intense pulsed light &#40;IPL&#41; therapy uses a broad spectrum&#44; high energy&#44; noncoherent light&#46; The underlying principle is photon absorption by endogen or exogen chromophores&#46; The transfer of energy to target cells &#40;in HA&#44; the occluded hair follicle unit&#41; generates heat&#44; destroying the lesion in a process termed selective photothermolysis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> IPL also has an antimicrobial effect due to the activation of bacterial porphyrins&#44; which generates reactive oxygen species and leads to cell death&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nd&#58;YAG&#44; carbon dioxide &#40;CO<span class="elsevierStyleInf">2</span>&#41;&#44; alexandrite&#44; and diode laser therapies have also been used to treat HS&#46; The aim of these treatments is to reduce the number of hair follicles in areas where HS lesions tend to develop&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This systematic review aimed to update our understanding of the efficacy and safety of the various modalities of light-based therapy applied in HS&#46; We considered both conventional PDT and intralesional and laser treatments&#46; However&#44; we did not compare them&#44; given that their mechanisms of action differ and publications are few&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Literature Search Strategy</span><p id="par0035" class="elsevierStylePara elsevierViewall">We searched for articles on light-based therapies used alone or with a photosensitizer &#40;PDT&#41; to treat HS&#46; Articles had to be published between August 2015 and March 1&#44; 2019&#46; Additional limiters were set to select studies in humans that were published in either Spanish or English&#46; We started the search with August 2015 because a systematic review in the Cochrane Library was updated at that time&#46; Our intention was to update that review with the results of more recent studies&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We also searched backwards from the reference lists to identify any cited articles meeting our inclusion criteria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following databases were used&#58; MEDLINE &#40;through PubMed&#41;&#44; EMBASE&#44; the Centre of Reviews and Dissemination &#40;University of York&#41;&#44; the Cochrane Library &#40;in the Cochrane Database of Systematic Reviews&#41;&#44; the Cochrane Skin Group&#44; the Centre of Evidence Based Dermatology &#40;University of Nottingham&#41;&#44; and TESEO &#40;the Andalusian database of PhD theses&#41;&#46; The following trial registries were also consulted&#58; ClinicalTrials&#46;gov&#44; reec&#46;aemps&#46;es&#44; and Clinicaltrialsregister&#46;eu&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally&#44; the PROSPERO register was searched for systematic reviews on HS&#46; We specified reviews that included light-based therapies&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Search terms were chosen from the list of Medical Subject Headings &#40;English&#41; and its equivalent in Spanish &#40;Descriptores en Ciencias de la Salud&#41;&#44; as follows&#58; photochemotherapy&#44; photodynamic therapy&#44; hidradenitis suppurativa&#44; suppurative hidradenitis&#44; light&#44; lasers&#44; laser therapy&#44; intense pulsed light therapy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Article inclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Type of study&#58; randomized controlled clinical trials &#40;RCTs&#41;&#44; systematic reviews&#44; observational studies with a control group&#44; and observational studies without a control group &#40;case series&#41;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Population&#58; adults with HS regardless of sex&#44; ethnicity&#44; comorbidity&#44; or prior treatment</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Limiter&#58; inclusion of patients whose HS was treated with PDT &#40;using any type of laser or other light source&#41;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Limiter&#58; publication in Spanish or English</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">Article exclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Publication outside the time frame</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Studies not using accepted&#44; validated HS evaluation tools &#40;eg&#44; the Hidradenitis Suppurativa Clinical Response criterion&#44; the modified Sartorius score&#44; and&#47;or the Physician Global Assessment &#91;PGA&#93; of HS&#41;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Case series with fewer than 5 patients</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Editorials and narrative reviews</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Data Management&#44; Extraction and Synthesis&#44; and Analysis of Research Design Quality</span><p id="par0110" class="elsevierStylePara elsevierViewall">Search results were downloaded with Mendeley reference management software&#44; with titles and abstracts in separate fields&#46; All duplicate&#44; discarded&#44; and selected references were recorded &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The literature searchers were not blinded to authors&#8217; names or institution or the publishing journal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The scale of Jadad et al<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> was used to evaluate RCTs&#46; Critical analysis was based on the CONSORT guidelines &#40;Consolidated Standards for Reporting Clinical Trials&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The tool of the Basque Office for Health Technology Assessment &#40;OSTEBA&#44; its Spanish acronym&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> was used to assess the quality of evidence afforded by several types of studies and build a table synthesizing the results&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Included and Excluded Studies</span><p id="par0120" class="elsevierStylePara elsevierViewall">Of the 199 studies found&#44; we excluded 164 after removing duplicates and assessing the titles and abstracts&#46; We evaluated 35 full texts&#44; excluding 24 that did not meet the inclusion criteria&#46; Some did not have 5 patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#44;16&#8211;37</span></a> &#40;See Appendix B&#44; supplementary material&#46;&#41; Because few clinical trials and systematic reviews were found&#44; we included case series even though their evaluation of efficacy and effectiveness is limited&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Thus&#44; we evaluated 6 case series &#40;5 prospective and 1 retrospective&#41;&#46; The evidence level was low in 4 of the series and moderate in 2 of them&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Most studies were carried out in Europe &#40;Spain&#44; the United Kingdom&#44; France&#44; and Italy&#41;&#44; the United States&#44; and Egypt&#46; The remaining inclusions were 2 moderate-quality RCTs and 3 high-quality systematic reviews&#46; The reviews included 4 trials and 5 case series on light-based treatments and are analyzed in depth in the present systematic review&#58; Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Calzavara-Pinton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Schweiger et al&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Sotiriou et al&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Mahmoud et al&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> and Xu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1&#8211;3</a> summarize the studies&#8217; periods of follow-up&#44; numbers of patients and losses&#44; population characteristics and interventions&#46; One relevant study<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> was found in a backward citation search of references&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Sample Size</span><p id="par0140" class="elsevierStylePara elsevierViewall">The number of participants in the included studies ranged widely&#46; The maximum was 38<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> and the minimum was 5&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;42</span></a> for a total of 248 patients &#40;mean&#44; 15&#46;5 patients&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Participants</span><p id="par0145" class="elsevierStylePara elsevierViewall">All the studies included men and women older than 18 years with a clinical diagnosis of HS&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">One study included only Hurley stage 1 patients &#40;Zerbinati et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a>&#41; and 1 included only Hurley stage 2 patients &#40;Mahmoud et al<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#41;&#46; Two studies included both Hurley 1 and 2 stages &#40;Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> and Fabbrocini et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a>&#41;&#46; Six studies required moderately severe HS &#40;Hurley stages 2 or 3&#41; at baseline &#40;Andino Navarrete et al&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Xu et al&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> and Sotiriou et al<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#41;&#46; One study included any stage of severity &#40;stages 1&#44; 2&#44; or 3&#41; &#40;Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a>&#41;&#46; Finally&#44; 5 studies did not specify stage &#40;Valladares-Narganes et al&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Calzavara-Pinton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> and Schweiger et al<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Study Designs</span><p id="par0155" class="elsevierStylePara elsevierViewall">We included 3 systematic reviews for this systematic update &#40;Ingram et al&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> John et al&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> and Robert et al<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#41; and 2 clinical trials &#40;Fadel and Tawfik<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> and Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a>&#41;&#46; The remaining studies were case series&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The systematic review of Ingram et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> included 3 RCTs comparing topical PDT&#44; IPL and Nd&#58;YAG laser therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;38&#44;39</span></a> Fadel and Tawfik<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> used an active comparator in the control group&#46; Controls were untreated in Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> whereas Tierney et al<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> applied 1&#37; clindamycin cream in the control group&#46; The systematic review of John et al<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> included 22 studies&#46; Three provided high-quality evidence &#40;and were also included by Ingram et al&#41;&#46; The only additional inclusion that met our criteria was that of Xu et al&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> which assessed Nd&#58;YAG laser treatment&#46; The most up-to-date systematic review was by Robert et al&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> who included 64 articles about the nonsurgical treatment of HS &#40;with medications or light therapies&#41;&#46; Studies of light-based treatments that were not included in the aforementioned reviews were those of Calzavara-Pinton et al<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> &#40;PDT with methyl aminolevulinate &#91;MAL&#93;&#41; and Schweiger et al<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> and Sotiriou et al<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> &#40;PDT with ALA&#41;&#46; This third systematic review also included two case series of patients treated with Nd&#58;YAG laser &#40;Mahmoud et al<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&#41; and CO<span class="elsevierStyleInf">2</span> laser &#40;Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Only 2 RCTs were retrieved&#46; One was by Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> which was found by backwards searching of citations as described above&#46; The other was by Abdel Azim et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> which evaluated a combined treatment with CO<span class="elsevierStyleInf">2</span> laser followed by Nd&#58;YAG laser&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">One of the case series we included studied the use of PDT with 20&#37; ALA as the photosensitizer and 635-nm laser &#40;Andino Navarrete et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#41;&#46; Three studies analyzed intralesional PDT&#46; Two used ALA at concentrations of 5&#37; and 1&#37; and a 630-nm laser light source&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a> The third used MB and a 635-nm light-emitting diode &#40;LED&#41; lamp &#40;Aktilite&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Zerbinati et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> analyzed case series in which Nd&#58;YAG laser was used&#44; and Fabbrocini et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> evaluated the efficacy of diode laser irradiation in mild to moderate HS&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Outcome Measures</span><p id="par0180" class="elsevierStylePara elsevierViewall">The included studies assessed outcomes in somewhat different ways&#46; Most used the Sartorius score of 2003&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;11&#44;38</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;41&#8211;43&#44;45&#44;47&#44;49</span></a> but 2 studies used the modified version of this score&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a> Five &#40;Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Abdel Azim et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Calzavara-Pinton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Fabbrocini et al&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> and Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&#41; used the PGA&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Six evaluated changes in quality of life with the Dermatology Life Quality Index &#40;DLQI&#41; published by Finlay in 1994&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;41&#44;42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">49&#44;50</span></a> General satisfaction was evaluated by Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> with an unvalidated Likert scale and by Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> with a score of 0 &#40;very unsatisfied&#41; to 10 &#40;very satisfied&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Two studies assessed pain during and after treatment using a visual analog scale &#40;VAS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;51</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Four studies provided information about adverse effects&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;51</span></a> although Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> only reported such effects if treatment had to be interrupted&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Finally&#44; 5 studies reported recurrence rates&#46; Agut-Busquet et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> emphasized recurrence&#44; explaining each case&#46; Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> reported recurrence in 9 patients&#46; Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> found that HS tended to recur 12 months after treatment&#46; Recurrence 3 and 12 months after treatment was assessed by Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> and Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> respectively&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Outcomes Obtained With Light-Based Therapies</span><p id="par0205" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1&#8211;3</a> summarize the research designs used and quality of evidence obtained by researchers studying the use of conventional PDT&#44; intralesional PDT&#44; and laser treatments&#46; As explained above&#44; the 3 systematic reviews we consulted included patients treated with both PDT and laser therapy&#46; Therefore&#44; to avoid repetition&#44; one table &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; presents the studies that applied laser treatments and IPL in bold face type&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">PDT</span><p id="par0210" class="elsevierStylePara elsevierViewall">Andino Navarrete et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> treated 5 patients with a 20&#37; ALA solution for 1&#46;5<span class="elsevierStyleHsp" style=""></span>h and then irradiated the area with a 635-nm LED lamp at a fluence of 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> and intensity of 70<span class="elsevierStyleHsp" style=""></span>mW&#47;cm<span class="elsevierStyleSup">2</span> per session&#46; The patients experienced improvements &#40;Sartorius score&#44; DLQI&#44; and VAS&#41; that was maintained at 8 weeks&#44; although the differences were not statistically significant&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Fadel and Tawfik<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> used PDT with a 0&#46;01&#37; MB gel &#40;formulation in liposomes with surfactants to increase penetration&#41; and compared it to placebo &#40;MB-free&#41; gel&#46; The area was irradiated with IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#41; for 20<span class="elsevierStyleHsp" style=""></span>ms at a fluence of 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The participants were authorized to receive treatment at every affected area of the body &#40;armpits&#44; buttocks&#44; groin&#44; and under the breasts&#41;&#46; Results showed a Sartorius score reduction of 77&#46;3&#37; &#40;liposome MB gel formulation&#41; and 44&#46;1&#37; &#40;MB-free placebo&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; The authors concluded that PDT with MB in this formulation is superior to irradiation after MB-free gel&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Calzavara-Pinton et al<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> studied patients with various diseases treated with MAL-PDT&#59; 6 patients with HS were among them&#46; The authors irradiated with red light &#40;635<span class="elsevierStyleHsp" style=""></span>nm&#41; every 2 weeks for 4 weeks and reported a PGA assessment of more than 75&#37; in 33&#37; of the cases&#44; moderate improvement in half&#44; and a poor response in 1 patient&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Schweiger et al<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> described 12 patients treated with ALA-PDT with blue light and IPL weekly for 4 weeks&#46; Four weeks after treatment they observed a reduction in the Sartorius score of 50&#46;8&#37;&#46; At 8 weeks the reduction was 29&#46;9&#37;&#46; The DLQI score fell from 17&#46;3 to 13&#46;1&#46; Blue light was tolerated better than IPL&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Finally&#44; Sotiriou et al<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> applied a 20&#37; ALA formulation in 5 sessions in 5 patients with Hurley stage 2 or higher HS&#46; The mean Sartorius score decreased from 18&#46;8&#37; to 17&#46;2&#37;&#44; and DLQI impact fell 6&#46;4&#37; on average&#46; These results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Intralesional PDT</span><p id="par0235" class="elsevierStylePara elsevierViewall">Valladares-Narganes et al<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> administered 1&#37; ALA &#40;0&#46;2<span class="elsevierStyleHsp" style=""></span>mL&#47;cm<span class="elsevierStyleSup">3</span>&#41; into lesions followed by light exposure&#44; as noted above&#44; in a series of 27 patients with 1 to 3 lesions each&#46; After 26&#46;21 months &#40;range&#44; 21&#46;07&#8211;68&#46;57 months&#41;&#44; responses were complete in 10 patients &#40;37&#37;&#41;&#44; moderate in 11 &#40;41&#37;&#41;&#44; and partial in 5 &#40;19&#37;&#41;&#46; The authors saw the best results in armpit lesions &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Agut-Busquet et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> injected a 1&#37; MB solution into lesions under ultrasound guidance in 7 patients&#46; After incubation &#40;15<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#44; the lesions were irradiated with an LED lamp &#40;Aktilite&#44; 635<span class="elsevierStyleHsp" style=""></span>nm&#44; 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; After 6 months the global assessment of response was 78&#37; in 1 patient&#44; 80&#37; in 1&#44; 90&#37; in 2&#44; and 99&#37; in 2&#46; Patients with Hurley stage 2 HS responded better &#40;99&#37;&#41; than those with Hurley stage 3 &#40;87&#37;&#41;&#44; and the best results were observed in groin lesions&#46; DLQI improved significantly for 6 patients&#44; coinciding with excellent response to treatment&#46; Mild adverse effects &#40;swelling or erythema&#41; were observed in 6 patients &#40;86&#37;&#41;&#44; but they resolved within a week &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> injected a 5&#37; ALA gel into lesions through a cannula placed along the sinus tract in 38 patients&#46; After incubation under opaque occlusion for 2<span class="elsevierStyleHsp" style=""></span>hours&#44; intralesional laser irradiation &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 1&#46;2<span class="elsevierStyleHsp" style=""></span>W&#59; fluence&#44; 180<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; was applied with a fiberoptic probe &#40;400<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; All regions treated improved according to modified Sartorius scale results&#46; There were 53 complete responses&#44; 7 good responses&#44; and 4 partial responses&#46; However&#44; the differences were not statistically significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Nd&#58;YAG Laser Treatment</span><p id="par0250" class="elsevierStylePara elsevierViewall">Tierney et al<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> compared Nd&#58;YAG treatments with 10&#37; benzoyl peroxide and daily application of 1&#37; clindamycin versus application of the topical antibiotic alone&#46; Seventeen patients were enrolled and 4 laser sessions were given at intervals of 1 month &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The reduction in severity according to modified Sartorius assessment was 65&#46;3&#37; at 3 months on average over all regions &#40;73&#46;4&#37; in the groin&#44; 62&#37; in the armpits&#44; and 53&#46;1&#37; under the breasts&#41;&#46; Improvement was significant in laser-treated patients&#44; but not in the control group &#40;topical clindamycin only&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Xu et al<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> published a prospective&#44; controlled histopathologic study in 19 patients with Hurley stage 2 HS&#46; The patients were treated in 2 monthly sessions of Nd&#58;YAG laser therapy &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41;&#46; The percent response to treatment on the Sartorius score after 2 months was 31&#46;6&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Greater improvement was recorded in groin lesions &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Zerbinati et al<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> observed a mean improvement of 85&#46;3&#37; in the Sartorius score with Nd&#58;YAG treatment of very early Hurley stage 1 HS in 12 patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In a similar study&#44; but with 22 patients with more severe HS &#40;Hurley stage 2&#41;&#44; Mahmoud et al<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> evaluated the response at 6 months to 4 sessions of a series of 1 long-pulse Nd&#58;YAG treatment per month for 4 months&#46; They also observed a decrease in the Sartorius score &#40;&#8722;72&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Other Types of Laser Treatment</span><p id="par0265" class="elsevierStylePara elsevierViewall">An RCT of CO<span class="elsevierStyleInf">2</span> laser treatment was carried out by Abdel Azim et al<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> in 20 patients over the age of 18 years who had Hurley stage 1 or 2 HS&#46; The aim was to assess the safety and efficacy of combining fractional CO<span class="elsevierStyleInf">2</span> irradiation with long-pulse Nd&#58;YAG laser irradiation &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in 4 sessions separated by 2 weeks&#46; On the intervention side the patients received fractional CO<span class="elsevierStyleInf">2</span> laser treatment followed by long-pulse Nd&#58;YAG laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in the same session&#46; On the control side&#44; only the Nd&#58;YAG treatment was used&#46; The authors concluded that improvement and satisfaction were greater with the combined treatment of early &#40;Hurley stage 1 and 2&#41; disease and that the recurrence rate was lower &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Of 9 patients with medically and surgically refractory HS who received CO<span class="elsevierStyleInf">2</span> laser treatments from Madan et al&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> 7 had achieved complete remission at 12 months&#46; Satisfaction was high &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Finally&#44; Fabbrocini et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> used laser diode light in a group with Hurley stage 1 or 2 HS and mild to moderate disease according to PGA&#46; The patients received 4 sessions spaced every 2 weeks&#46; A significant reduction of 31&#37; was seen in the Sartorius scores&#44; which changed from 28&#46;55 &#40;SD&#44; 13&#46;04&#41; to 19&#46;75 &#40;SD&#44; 12&#46;29&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The authors also reported a direct association between improvement and better quality of life &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">IPL</span><p id="par0280" class="elsevierStylePara elsevierViewall">Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> enrolled 18 patients in an RCT comparing active and control treatments on contralateral sides&#46; The active treatment was IPL &#40;50<span class="elsevierStyleHsp" style=""></span>ms&#44; 420<span class="elsevierStyleHsp" style=""></span>nm&#44; fluence of 7&#8211;10<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; They observed a mean reduction in the Sartorius score of 12&#37; immediately after therapy&#44; 10&#37; at 3 to 6 months&#44; and 3&#37; at 12 months&#46; The difference between the treated and control sides was significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Patient satisfaction was high&#46; Response was complete in 1 case&#44; excellent in 2 cases&#44; good in 10&#44; and moderately good in 4&#46; Fifteen did not experience significant changes on the control side&#58; 1 patient reported slight improvement and another experienced slight worsening&#46; The treatment was applied once a week for 4 weeks&#46; Follow-up was 12 months &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0285" class="elsevierStylePara elsevierViewall">Considering the limited evidence available for light-based treatments for HS&#44; it is difficult to draw conclusions about the efficacy of either intralesional versus topical approaches&#44; or IPL or Nd&#58;YAG laser&#46; Variation in study designs makes comparison difficult&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">We identified 3 photosensitizers being used in PDT&#58; ALA&#44; MAL&#44; and MB&#46; All of them were applied at different concentrations from 1&#37; to 20&#37; for ALA&#44; 16&#37; for MAL&#44; and 0&#46;01&#37; to 1&#37; for MB&#46; Which concentration leads to a better response rate is difficult to establish because evaluation methods differ&#46; Moreover&#44; the type of light used to irradiate lesions also varies&#44; as some groups use LED lamps&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;40&#44;42</span></a> while others apply external<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or intralesional laser<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#44;51</span></a> and still others use IPL&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;41</span></a> The possibility of treating deep HS lesions is an important factor in efficacy&#44; yet these light sources have frank differences in penetration&#46; The light doses also differ&#44; although the wavelength applied is similar at 630 or 635<span class="elsevierStyleHsp" style=""></span>nm&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">The studies also treated lesions at different sites&#44; for different durations and numbers of sessions &#40;from 1<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> to 12<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#41;&#46; The main difference in technique&#44; however was between the use of topical versus intralesional application of both the photosensitizer &#40;ALA&#44; MAL&#44; or MB&#41; and the light source &#40;LED&#44; laser&#44; or IPL&#41;&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">We found that intralesional treatment approaches also differed between authors&#46; Su&#225;rez Valladares et al<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> and Valladares-Narganes et al<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> used 630-nm diode lasers and ALA at different concentrations&#46; They assessed response with the modified Sartorius score&#44; finding that response was better with a 5&#37; ALA gel and a 400-nm diode laser &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>W and 180<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the other hand&#44; used a 1&#37; MB formulation and a 635-nm LED with a fluence of 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; They assessed efficacy with the DQLI and the Sartorius score&#44; reporting responses that varied from 99&#37; for cases involving Hurley stage 1 to 87&#37; in Hurley stage 3&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">The single study of IPL we found reported that statistically significant improvement was maintained for 12 months and that the risk of complications was low&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">The RCT of Nd&#58;YAG laser treatment by Tierney et al<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> demonstrated efficacy&#46; Later case series describing this treatment have reported reduction in the number of exacerbations and in severity&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;47</span></a> Efficacy has been reported to be greater in the groin&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">Very few studies have been published on other types of lasers&#44; but all of them report promising results&#46; The combination of CO<span class="elsevierStyleInf">2</span> and Nd&#58;YAG lasers obtained better results than Nd&#58;YAG irradiation alone and patient satisfaction was higher&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Madan et al<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> showed that CO<span class="elsevierStyleInf">2</span> laser therapy and marsupialization also led to high rates of complete remission in spite of adverse effects&#44; such as hypertrophic scarring&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">We found a single study of diode laser therapy for HS that was considered mild to moderate according to the PGA&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> The authors reported clinical and quality-of-life improvement after therapy&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">In summary&#44; the evidence supporting the use of light-based therapies for HS is limited&#46; There are 2 major groupings of these therapies according to whether a photosensitizer is used or not&#46; In 1 group&#44; for which only a low-moderate level of evidence is available&#44; the authors applied Nd&#58;YAG laser&#44; CO<span class="elsevierStyleInf">2</span> laser&#44; or IPL&#46; In the other&#44; for which the quality of evidence is also low-moderate&#44; PDT &#40;with photosensitizer&#41; was used&#46; Thus&#44; all the treatments reviewed used light but they are not comparable&#58; different techniques have different mechanisms of action&#46; However&#44; results for individual treatments do seem to suggest that approaches that offer greater penetration &#8212; whether by means of intralesional application or lasers &#8212; lead to better results&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">RCTs are necessary to confirm the efficacy of these treatments&#46; We also need to see standardized research protocols applying the design that is most appropriate for providing stronger evidence for the efficacy and safety of each technique&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Authorship</span><p id="par0335" class="elsevierStylePara elsevierViewall">T&#46; Gracia Caza&#241;a and L&#46;V&#46; Berdel Garc&#237;a contributed equally to this article&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "sec0090"
          "titulo" => "Authorship"
        ]
        9 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:2 [
          "identificador" => "xack457708"
          "titulo" => "Acknowledgments"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-03-17"
    "fechaAceptado" => "2019-04-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1222589"
          "palabras" => array:4 [
            0 => "Hidradenitis suppurativa"
            1 => "Photodynamic therapy"
            2 => "Laser"
            3 => "Intense pulsed light"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1222588"
          "palabras" => array:4 [
            0 => "Hidradenitis supurativa"
            1 => "Terapia fotodin&#225;mica"
            2 => "L&#225;ser"
            3 => "Luz intensa pulsada"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Treatment options for hidradenitis suppurativa include light-based therapy&#46; This systematic review aimed to update our understanding of the efficacy&#44; effectiveness and safety of these treatments for hidradenitis suppurativa by evaluating the literature published since the 2015 Cochrane review on this topic&#46; We conducted an electronic search of the following databases&#58; MEDLINE&#44; EMBASE&#44; University of York Centre for Reviews and Dissemination database&#44; Cochrane Database of Systematic Reviews&#44; Cochrane Skin Group Specialised Skin Register&#44; University of Nottingham&#8217;s Centre of Evidence Based Dermatology database&#44; and TESEO&#46; The systematic review included 6 case series&#44; 3 systematic reviews&#44; and 2 clinical trials on the use of conventional and intralesional photodynamic therapy&#44; intense pulsed light therapy&#44; and Nd&#58;YAG&#44; carbon dioxide&#44; and diode laser therapy for hidradenitis suppurative in 248 patients&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La terapia con luz es una alternativa en el tratamiento de la hidradenitis supurativa &#40;HS&#41;&#46; El objetivo fue evaluar la eficacia&#44; efectividad y seguridad de las distintas modalidades de terapia con luz en la HS&#44; mediante una revisi&#243;n sistem&#225;tica actualizando la realizada en 2015 procedente de Cochrane Library&#46; Se identificaron los estudios mediante una b&#250;squeda electr&#243;nica en las bases de datos&#58; MEDLINE&#44; EMBASE&#44; Universidad de York&#44; Cochrane Database of Systematic Reviews&#44; Cochrane Skin Group&#44; Centre of Evidence based dermatology de la Universidad de Nottingham&#44; TESEO finalmente se incluyeron 6 series de casos y 3 revisiones sistem&#225;ticas y 2 ensayos cl&#237;nicos de pacientes tratados con terapia fotodin&#225;mica convencional o intralesional&#44; l&#225;ser Nd&#58;YAG&#44; CO2 o diodo y luz intensa pulsada&#44; con un total de 248 pacientes tratados&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Gracia Caza&#241;a T&#44; et al&#46; Revisi&#243;n sistem&#225;tica de las terapias con luz en el tratamiento de la hidrosadenitis supurativa&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;89&#8211;106&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0360" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0105"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2460
            "Ancho" => 2335
            "Tamanyo" => 284463
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the literature search for this systematic review&#46; TESEO is the database of doctoral theses in Andalusia&#44; Spain&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ALA&#44; 5-aminolevulinic acid&#59; CO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide&#59; DLQI&#44; Dermatology Life Quality Index&#59; HS&#44; hidradenitis suppurativa&#59; HS-LASI&#44; HS lesion&#44; area and severity index&#59; IPL&#44; intense pulsed light&#59; MAL&#44; methyl aminolevulinate&#59; MB&#44; methylene blue&#59; Nd&#58;YAG&#44; neodymium and neodymium&#58;yttrium aluminum garnet&#59; PDT&#44; photodynamic therapy&#59; QoL&#44; quality of life&#59; RCT&#44; randomized clinical trial&#59; VAS&#44; visual analog scale&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design&#44; Aim and Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention and Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of Evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Andino Navarrete et al&#44;<span class="elsevierStyleSup">2</span> 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To assess the efficacy &#40;Sartorius&#44; DLQI&#41; and safety of PDT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ALA and 635-nm light treatment of moderate to severe HS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 5<span class="elsevierStyleItalic">Characteristics&#58;</span> HS type 2 or Hurley stage 3&#59; 4 armpit lesions&#44; bilateral &#43; 1 pubic&#59;1 man&#44; 4 women&#59;Mean age&#44; 26<span class="elsevierStyleHsp" style=""></span>&#40;5&#41; y&#59; Mean time since onset&#44; 4<span class="elsevierStyleHsp" style=""></span>&#40;1&#41; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; ALA solution for 1&#46;5<span class="elsevierStyleHsp" style=""></span>h&#59; light &#40;635<span class="elsevierStyleHsp" style=""></span>nm&#44; 37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 70<span class="elsevierStyleHsp" style=""></span>mW&#47;cm<span class="elsevierStyleSup">2</span>&#41; per sessionMinimum 4 sessions spaced 1&#8211;2 wk<span class="elsevierStyleItalic">Follow-up&#58;</span> 4 and 8 wk<span class="elsevierStyleItalic">Losses&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Significantly improved severity&#44; DLQI&#44; and VAS scores at 8 wkMean Sartorius decrease of 35<span class="elsevierStyleHsp" style=""></span>&#40;5&#41; to 18<span class="elsevierStyleHsp" style=""></span>&#40;8&#41; pointsDLQI decrease&#44; 21 points after 4 sessions&#44; sustained at 8 wkVAS pretreatment&#44; 3&#59; decrease &#40;0&#8211;1&#41; at 4 and 8 wk&#44; all patientsOnly adverse effect&#44; burning on irradiation &#40;2 patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment with topical 20&#37; ALA and 635-nm light could be effective for refractory HS&#44; decreasing severity and improving QoL&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small series&#44; limiting external validity and extrapolation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> single-blind RCT<span class="elsevierStyleItalic">Objectives&#58;</span> To assess the efficacy and safety of MB niosome gel as photosensitizer in IPL treatment of HS<span class="elsevierStyleItalic">Study period&#58;</span>6 mo &#40;month and year not specified&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 17&#44; intraindividual &#40;contralateral control&#41;&#59; 6 exclusions&#59; 11 cases analyzed&#46;<span class="elsevierStyleItalic">Characteristics&#58;</span> 7 women&#44; 4 men&#59; mean age 27&#46;1 y &#40;range&#44; 17&#8211;35 y&#41;&#46;Lesions&#58; both armpits &#40;4&#41;&#59; multiple gluteal &#40;3&#41;&#59; groin &#40;2&#41;&#59; under breasts &#40;1&#41;&#46;No topical or systemic treatment 2 weeks before enrollment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervention side&#58;</span> PDT with topical 0&#46;01&#37; MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#41; every 2 wk2 sessions&#47;mo up to 6 mo<span class="elsevierStyleItalic">Control side&#58;</span> PDT with placebo topical MB-free gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; every 2 wk<span class="elsevierStyleItalic">Follow-up&#58;</span> 1&#44; 3&#44; and 6 mo after treatments<span class="elsevierStyleItalic">Losses after randomization&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDT with topical 0&#46;01&#37; MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL was superior to placebo gel&#59; reduction of Sartorius score by 77&#46;3&#37; and 44&#46;1&#37;&#44; respectively&#46;Mean HS-LASI improvement was significant in both groups&#58; active treatment&#44; 77&#46;3&#37; &#40;18&#46;86&#37;&#41;&#59; vs placebo gel&#44; 44&#46;1&#37; &#40;28&#46;19&#37;&#41;Similar adverse effects &#40;pain&#44; erythema&#44; hyperpigmentation&#41;&#59; no effect of treatment site or disease stage<span class="elsevierStyleItalic">Adverse effects&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#41; with this photosensitizer &#40;MB&#41; is effective&#46; MB in niosome formulation enhances dermal penetration&#46;Hair follicle destruction was also attributed to 630-nm &#955; ray&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited by small sample size and short follow-up period&#46; Intraindividual RCTs with more patients and longer follow-up are needed&#46; RCTs with comparators &#40;medical and surgical treatments&#41; are also needed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ingram et al&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> systematic review of RCTs<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the effects of interventions for HS in persons of any age<span class="elsevierStyleItalic">Period searched&#58;</span> 1983&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any person &#40;any sex&#44; age&#44; or ethnicity&#41; with a clinical diagnosis of HS made by a physician and based on a standard definition of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions&#58;</span> More than 40 interventions for HS were included&#44; though evidence was lacking for many&#46; Interventions grouped as pharmacologic&#44; surgical&#44; and other&#46; 3 trials&#58;<span class="elsevierStyleItalic">Fadel and Tawfik&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleItalic">2015</span>Intervention 1&#58; PDT with topical 0&#46;01&#37; MG gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; every 2 wkIntervention 2&#58; PDT with placebo gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; 20<span class="elsevierStyleHsp" style=""></span>ms&#44; 25<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; every 2 wk&#44;2 sessions&#47;mo up to 6 mo<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Highton et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2011</span></span><span class="elsevierStyleBold">randomized sides&#44; 1 untreated control side and 1 treated with IPL&#44; twice weekly for 4 wk &#40;420<span class="elsevierStyleHsp" style=""></span>nm&#44; 7&#8211;10<span class="elsevierStyleHsp" style=""></span>J&#47;cm</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleBold">a 50<span class="elsevierStyleHsp" style=""></span>ms&#41;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Tierney et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2009</span></span><span class="elsevierStyleBold">Left and right sides of the same anatomical structure received 1 of the following treatments&#58;</span><span class="elsevierStyleBold">- 10&#37; benzoyl peroxide wash and</span> 1&#37; <span class="elsevierStyleBold">clindamycin in gel or lotion &#40;frequency not indicated&#41;&#46;</span><span class="elsevierStyleBold">- 4 Nd&#58;YAG laser treatments monthly and topical</span> 10&#37; <span class="elsevierStyleBold">benzoyl peroxide and</span> 1&#37; <span class="elsevierStyleBold">clindamycin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of studies and patients&#58;</span> 12 trials with 615 patients Median&#44; 27 participants&#59; mean duration of treatment&#44; 16 wk&#46; Included studies were done between 1983 and 2015&#46;<span class="elsevierStyleItalic">Effect size&#58;</span> The 3 trials of laser or other light-based treatments were judged to offer a low level of evidence because of lack of precision and adequate blinding&#46;<span class="elsevierStyleItalic">Fadel and Tawfik&#44;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a><span class="elsevierStyleItalic">2015</span>PDT with topical 0&#46;01&#37; MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL was superior to placebo MB gel<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IPL&#59; Sartorius score fell by 77&#46;3&#37; and 44&#46;1&#37;&#44; respectively<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Highton et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2011</span></span><span class="elsevierStyleBold">Significant benefit from IPL in 18 patients&#58; mean Sartorius score reduction of</span> 12&#37; <span class="elsevierStyleBold">immediately after therapy&#44;</span> 10&#37; <span class="elsevierStyleBold">at 3 months&#44;</span> 10&#37; <span class="elsevierStyleBold">at 6 months&#44; and</span> 3&#37; <span class="elsevierStyleBold">at 12 months&#46; No comparator&#46; Patients assessed satisfaction on an unvalidated Likert scale&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Tierney et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2009</span></span><span class="elsevierStyleBold">17 patients&#44; 4 Nd&#58; YAG laser treatments at monthly intervals on 1 side of the body in 25 regions with lesions&#46; Significantly improved Sartorius scores in treated armpits&#46; A 6</span>5&#46;3&#37; <span class="elsevierStyleBold">reduction in HS severity at 3 mo overall&#46; By locations&#58; 7</span>3&#46;4&#37; <span class="elsevierStyleBold">groin&#44;</span> 62&#37; <span class="elsevierStyleBold">armpits&#44; 5</span>3&#46;1&#37; <span class="elsevierStyleBold">under breasts&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Studies of Nd&#58;YAG laser&#44; IPL&#44; and topical PDT treatments were of poor quality because of lack of blinding and absence of placebo comparison&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">John et al&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> systematic review of RCTs and nonrandomized trials&#44; other systematic reviews&#44; case&#8211;control cohort studies&#44; case series&#44; and expert opinion<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the effects of laser treatment of HS in persons of all ages<span class="elsevierStyleItalic">Period searched&#58;</span> 1987&#8211;April 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Any individual regardless of sex&#44; age&#44; or ethnicity with a diagnosis of HS treated by any type of laser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions&#58;</span> 47 studies found&#59; 22 analyzed after applying inclusion and exclusion criteriaTwo studies provided grade A evidence &#40;Jadad scale&#41; and 1 provided grade B evidence&#46;Laser therapy was assessed in 3 studies&#58;Higher quality evidence &#40;grade A&#44; Jadad&#41; from Highton et al&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> both included in the systematic review of Ingram et al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> &#40;above&#41;&#46;<span class="elsevierStyleBold">Xu et al</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleBold">provided grade B evidence &#40;Jadad&#41;&#46;</span><span class="elsevierStyleBold">19 patients with Hurley stage 2 HS treated with long-wave Nd&#58;YAG laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; twice monthly</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of studies and patients&#58;</span> 22 studies&#44; 2 with grade A evidence&#44; 1 with grade B&#44; and the rest with grade C &#40;very low&#41;In total&#44; 59 patients were treated in grade A or B studies&#46; The included studies were done between 1987 and 2016&#46;<span class="elsevierStyleItalic">Effect size&#58;</span> grade A evidence assigned to the trials of Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and Tierney et al&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> as explained in the entry for the inclusions of the systematic review of Ingram et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Xu et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2011</span>&#44; grade B&#46; The percent change in Sartorius score after 2 mo of treatment was 31&#46;6&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; on average for all lesion sites&#59; 24&#46;4&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; for armpits and 36&#46;8&#37; for groin &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; But on histology 3 patients still had inflammation&#44; and the percent changes were not clinically significant&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The conclusion was that there was moderate support for the efficacy long-pulse Nd&#58;YAG laser and IPL in HS and for reducing recurrence by means of hair follicle destruction&#59; and limited evidence for CO<span class="elsevierStyleInf">2</span> laser<span class="elsevierStyleInf">&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Large RCTs&#44; preferably multicenter ones&#44; are needed to standardize assessment techniques and assess efficacy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Robert et al&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> systematic review of RCTs and nonrandomized trials&#44; other systematic reviews&#44; case&#8211;control cohort studies&#44; case series&#44; and expert opinion<span class="elsevierStyleItalic">Objective&#58;</span> To summarize and analyze research on current nonsurgical techniques for treating HS<span class="elsevierStyleItalic">Period searched&#58;</span> January 2005&#8211;September 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Included&#58;</span> all original research articles on nonsurgical HS treatments &#40;RCTs&#44; prospective or retrospective observational studies&#44; and case series of at least 4 patients&#41;<span class="elsevierStyleItalic">Excluded&#58;</span> single case studies&#44; narrative reviews&#44; discussions&#44; opinion articles&#44; research letters&#44; and editorials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions&#58;</span> 64 included articles&#46; Evidence level generally low&#59; most were retrospective observational studies&#46;Biological treatments &#40;44&#37;&#41;&#44; PDT or other phototherapies &#40;16&#37;&#41;&#44; antibiotic therapy &#40;11&#37;&#41;&#44; laser &#40;8&#37;&#41;&#44; retinoids &#40;6&#37;&#41;&#44; and other immunosuppressant therapies&#46;10 articles on PDT&#58; 4 have already been mentioned elsewhere in our review &#40;Fadel and Tawfik&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Valladares-Narganes et al&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> Andino Navarrete et al&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Highton et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41;&#46; After applying our inclusion and exclusion criteria&#44; we evaluated the following&#58;<span class="elsevierStyleItalic">Calzavara-Pinton et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">2013</span>&#44; treated 6 patients &#40;no Hurley stage reported&#41; with MAL-PTD &#40;red light&#44; 635<span class="elsevierStyleHsp" style=""></span>nm&#41; every 2 wk for 4 wk<span class="elsevierStyleItalic">Schweiger et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleItalic">2011</span>&#44; treated 12 patients with ALA-PTD &#40;IPL or blue light&#41;&#44; weekly for 4 wk<span class="elsevierStyleItalic">Sotiriou et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleItalic">2009</span>&#44; treated 5 patients &#40;Hurley stage 2 or higher with 20&#37; ALA and red light &#40;570&#8211;670<span class="elsevierStyleHsp" style=""></span>nm&#41; 3<span class="elsevierStyleHsp" style=""></span>h later&#59; 4 sessions at 15-d intervals&#59; assessment with VAS&#44; Sartorius score and DLQI<span class="elsevierStyleBold">Laser was used in 5 studies&#46; We excluded 2 reports of &#60;5 patients or with nonvalidated assessment tools and Mikkelsen et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleBold">a retrospective series that was not relevant &#40;only evaluating long-term recurrence after CO<span class="elsevierStyleInf">2</span> laser&#41;&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Mahmoud et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2010</span>&#44; treated 22 patients &#40;Hurley stage 2&#41; with 4 sessions of long-pulse Nd&#58;YAG laser monthly for 4 mo&#59; follow-up&#44; 6 mo&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Madan et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2008</span>&#44; treated 9 medically and surgically refractory cases of HS with CO<span class="elsevierStyleInf">2</span> &#40;1 session&#44; follow-up at 12 mo&#41;&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of studies&#44; patients and effect sizes&#58;</span><span class="elsevierStyleItalic">Calzavara-Pinton et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleItalic">2013</span>&#44; assessed response by PGA&#46; Response was &#62;75&#37; in 33&#37; of patients&#44; moderate in half&#44; and &#60;50&#37; in 1&#46;<span class="elsevierStyleItalic">Schweiger et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleItalic">2011</span>&#44; saw a Sartorius score reduction of 50&#46;8&#37; at 4 wk and 29&#46;9&#37; at 8 wk&#46; Mean DLQI scores were 17&#46;3 at baseline and 13&#46;1 at 4 wk&#46; Tolerance was better with blue light than IPL&#46;<span class="elsevierStyleItalic">Sotiriou et al&#44;</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleItalic">2009</span>&#44; reported that mean Sartorius scores went from 18&#46;8 at baseline to 17&#46;2 on treated sides at the first follow-up visit&#46; Mean VAS evaluations of disease activity&#47;pain went from 2&#46;4 to 2&#46;1&#46; DLQI scores fell by 6&#46;4&#37;&#46;<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Mahmoud et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2010&#44;</span> measured the effect of Nd&#58;YAG laser in 22 patients with the Sartorius score&#44; reporting a 72&#37; reduction&#46;</span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Madan et al&#44;</span></span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a><span class="elsevierStyleBold"><span class="elsevierStyleItalic">2008&#44;</span> reported the PGA of the effect&#59; 7 out of 9 patients had complete remission and expressed high satisfaction&#46;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No nonsurgical treatment leads to long-term remission&#46; The authorsemphasized the need for surgery in refractory and debilitating cases&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low quality of evidence&#46; Heterogeneous methods of assessment&#44; scarcely comparable&#46; Few RCTs&#59; most studies are of retrospective cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Means are shown with the SD in parentheses&#46;</p>"
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            1 => array:3 [
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              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Bold face indicates articles obtained from systematic reviews in which light-based therapies other than PDT were used&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summary of Studies Included in Systematic Reviews That Used PDT Alone or in Combination With Surgery to Treat HS<a class="elsevierStyleCrossRefs" href="#tblfn0005"><span class="elsevierStyleSup">a&#44;b</span></a></p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BMI&#44; body mass index&#59; DLQI&#44; Dermatology Life Quality Index&#59; E&#44; energy &#59; HS&#44; hidradenitis suppurativa&#59; HSS&#44; hidradenitis severity score&#59; IR&#44; irradiation&#59; MB&#44; methylene blue&#59; PDT&#44; photodynamic therapy&#59; PGA&#44; Physician&#8217;s Global Assessment&#59; RCT&#44; randomized clinical trial&#59; VAS&#44; visual analog scale&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design&#44; Aim and Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention and Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valladares-Narganes et al&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To apply PDT with intralesional light probes that can reach different depths with light at the lowest energy level possible<span class="elsevierStyleItalic">Study period&#58;</span> March&#8211;November 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span>27 &#40;single group&#41;<span class="elsevierStyleItalic">Characteristics&#58;</span><elsevierMultimedia ident="202004140650279201"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional 1&#37; ALA solution &#40;dose&#44; 0&#46;2<span class="elsevierStyleHsp" style=""></span>mL&#47;cm<span class="elsevierStyleSup">3</span>&#41;&#46;By cannula inserted into fistulous tracts&#44; or needle injection into the diseased area if cannulation was impossible&#46;The entrance to and exit from the fistula was covered for an incubation period of 3<span class="elsevierStyleHsp" style=""></span>h&#46; Next&#44; the fistula was irradiated intralesionally with a continuous diode laser &#40;630<span class="elsevierStyleHsp" style=""></span>nm&#44; fiberoptic probe 1<span class="elsevierStyleHsp" style=""></span>mm in diameter&#59; 1<span class="elsevierStyleHsp" style=""></span>W&#47;cm<span class="elsevierStyleSup">3</span>&#59; 180<span class="elsevierStyleHsp" style=""></span>J&#41;&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; Light was transmitted through a 1-mm needle&#46;If response was suboptimal or new lesions appeared nearby&#44; an additional session was given&#46;<span class="elsevierStyleItalic">Follow-up&#58;</span> 1&#44; 3&#44; and 6 mo<span class="elsevierStyleItalic">Losses&#58;</span> 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Results on the modified Sartorius scale&#58; 10 &#40;37&#37;&#41; complete&#44; 11 &#40;41&#37;&#41; good&#44; and 5 &#40;19&#37;&#41; partial&#46;Best results in the armpits &#40;complete response in 6 of 8&#41;&#44; including patients requiring treatment of both armpits&#46;Moderate pain in 4 patients &#40;VAS&#44; 6&#8211;9&#41;Most patients &#40;22 of 27&#41; tolerated the procedure well &#40;VAS scores under 6&#41;&#46;Adverse effects included postprocedural pain&#44; erythema and slight swelling&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional PDT may be an effective and long-lasting treatment for HS&#46;The best results are in isolated lesions in the armpits or sacral and breast regions&#44; where most lesions are found&#46; Multiple&#44; interconnected fistulas require more sessions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RCTs would be a good step toward adequate assessment of therapies alone or in combination&#46; Trials should include dose detection and patient-relevant outcome measures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agut-Busquet et al&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> respective case series<span class="elsevierStyleItalic">Objective&#58;</span> To describe the experience with 7 patients with HS treated with PDT using intralesional MB and light &#40;635<span class="elsevierStyleHsp" style=""></span>nm&#41;<span class="elsevierStyleItalic">Study period&#58;</span> 8 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 7<span class="elsevierStyleItalic">Characteristics&#58;</span> HS clinical type 2&#44; Hurley stage 3&#44; at least 1 active zone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional 1&#37; MB solution injected with or without ultrasound guidance&#46;After incubation &#40;15<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; irradiation with a 635-nm LED light &#40;37<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;1&#8211;2 sessions&#44; intervals of 15 d&#46;<span class="elsevierStyleItalic">Follow-up&#58;</span> 1&#44; 2&#44; 4&#44; and 6 mo<span class="elsevierStyleItalic">Losses&#58;</span> 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hurley stage-2 patients responded better than stage-3 patients &#40;99&#37; vs 87&#37; improvement&#41;&#59; best results in the groin&#46;DQLI improvement in 6 patients&#58; 78&#37; &#40;1&#41;&#44; 80&#37; &#40;1&#41;&#44; 90&#37; &#40;2&#41;&#44; and 99&#37; &#40;2&#41;&#46;Evaluation&#44; Sartorius score and PGA&#58; 78&#37; &#40;1 patient&#41;&#44; 80&#37; &#40;1&#41;&#44; 90&#37; &#40;2&#41;&#44; 99&#37; &#40;2&#41;&#46;Good response &#40;86&#37; improvement&#41; to antibiotic in only 1 patient&#46;<span class="elsevierStyleItalic">Adverse effects&#58;</span> mild in 6 cases &#40;86&#37;&#41;&#59; serious in 1 patient &#40;cellulitis at treatment site&#44; attributed to patient&#8217;s manipulation of the area after therapy&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional PDT with MB gives good results in HS but is more effective in Hurley stage 2 than stage 3&#46;RCTs are necessary to improve the quality of evidence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Few patients&#44; making extrapolation to the general population &#40;external validation&#41; difficult&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Su&#225;rez Valladares et al&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the efficacy of intralesional PDT for the local management of HS in the short and medium term in different sites<span class="elsevierStyleItalic">Study period&#58;</span> March 2011&#8211;November 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 38<span class="elsevierStyleItalic">Characteristics&#58;</span>Sex&#58; 20 women&#44; 18 menAge&#58; 30&#8211;44 yWeight&#58; 67&#46;25&#8211;90<span class="elsevierStyleHsp" style=""></span>kgMean &#40;SD&#41; BMI&#58; 26&#46;87 &#40;4&#46;89&#41;BMI &#62;27&#58; 20Smokers&#58; 34Prior treatments&#58; 2&#44; none&#59; 1&#44; topical&#59; 23&#44; oral antibiotics&#59; 2&#44; oral retinoids&#59; 1&#44; biologic&#59; 9&#44; surgery&#46;Hurley stages&#58; 1&#44; 4 patients&#59; 2&#44; 21 patients&#59; 3&#44; 13 patients&#46;Direct measures of severity&#58; Hurley&#44; baseline&#47;total HSS&#44; and DLQI indicated high disease activity&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After local anesthesia&#44; 5&#37; ALA gel was injected through a cannula to fill the fistulous tracts&#46; Thus&#44; all walls of fistulous tracts were treated regardless of depth&#46; A lyophilized 1&#37; solution was injected into nodules&#46; Incubation under occlusion for 2<span class="elsevierStyleHsp" style=""></span>h before irradiation&#46; Irradiation &#40;1&#46;2<span class="elsevierStyleHsp" style=""></span>W&#59; fluence&#44; 180<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; with an intralesional 630-nm laser through a 400-mm fiberoptic probe inserted through a needle&#46;Follow-up visits every 5&#8211;7 wk<span class="elsevierStyleItalic">Follow-up&#58;</span> 26&#46;1 &#40;21&#46;7&#8211;68&#46;57&#41; mo<span class="elsevierStyleItalic">Losses&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Single session regardless of site&#44; but the median energy used was greater in the armpits&#46;Complete remission in 76&#46;3&#37;&#44; mean disease-free period of 168 wk&#46; New lesions at untreated sites were observed in 9 patients &#40;23&#46;7&#37;&#41;&#59; 6 of them had complete remission&#46;Recurrence or no remission after treatment in 9 patients&#44; in whom the percentages of obesity &#40;33&#46;&#37; vs 58&#46;6&#37;&#41; and smoking &#40;66&#46;7 vs 96&#46;6&#37;&#41; were lower but disease severity was greater &#40;44&#46;4&#37; vs 31&#37;&#41;&#44; modified Sartorius score was higher &#40;36 vs 22&#41; and DLQI poorer &#40;16 vs 10&#41; than in those with a good response to PDT&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional PDT might offer a new alternative treatment for HS lesions&#44; alone or in combination&#59;a high rate of complete remission was achieved and was long-lasting&#46;No complications observed&#46;Rapid recovery after treatment&#44; with the possibility of repeating sessions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Summary of Articles on Intralesional PDT for HS</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide&#59; DLQI&#44; Dermatology Life Quality Index&#59; HS&#44; hidradenitis suppurativa&#59; Nd&#58;YAG&#44; neodymium-doped yttrium aluminum garnet&#59; PGA&#44; Physician&#8217;s Global Assessment&#59; RCT&#44; randomized clinical trial&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Design&#44; Aim and Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention and Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zerbinati et al&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the clinical and histologic effects of Nd&#58;YAG laser treatment of HS<span class="elsevierStyleItalic">Study period&#58;</span> not specified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 12<span class="elsevierStyleItalic">Characteristics&#58;</span> Hurley stage 1 HSMean age 39&#46;5 y &#40;range&#44; 24&#8211;50 y&#41;&#44; bilateral disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in 300&#8211;600-&#956;m polycarbonate-coated glass optical fiber&#59;fluence&#44; 300<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; Different fiber diameters were used according to lesion size and site&#46;Pulse energy&#44; 150&#8211;350<span class="elsevierStyleHsp" style=""></span>mJ&#44;3 laser sessions &#40;1 every 2 mo&#41;&#46;<span class="elsevierStyleItalic">Follow-up&#58;</span> 12 mo<span class="elsevierStyleItalic">Losses&#58;</span> 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean percent Sartorius score improvement&#44; 85&#46;3&#37;&#46;Decrease in inflammatory infiltrate confirmed histologically&#59; fibrosis 4 mo posttreatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG laser is a well-tolerated&#44; noninvasive alternative treatment for this chronic&#44; debilitating disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">More patients should be followed for longer periods to provide stronger evidence for conclusions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nd&#58;YAG and CO<span class="elsevierStyleInf">2</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdel Azim et al&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> RCT&#44; intraindividual&#44; blinded<span class="elsevierStyleItalic">Objectives&#58;</span> To study the safety and efficacy of combined treatment with fractional CO<span class="elsevierStyleInf">2</span> and long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser for treating HS&#46;<span class="elsevierStyleItalic">Study period&#58;</span> January&#8211;December 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 20 &#40;30 enrolled&#44; 10 excluded&#41;<span class="elsevierStyleItalic">Characteristics&#58;</span> patients &#62;18 y with bilateral Hurley stage 1 or 2 lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervention&#58;</span> 4 laser sessions at 2-wk intervals&#46; Intervention-side treatment was combined fractional CO<span class="elsevierStyleInf">2</span> followed by long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser in the same session&#46;<span class="elsevierStyleItalic">Control&#58;</span> contralateral side&#44; long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser only<span class="elsevierStyleItalic">Follow-up&#58;</span> 3 mo after last session<span class="elsevierStyleItalic">Losses after randomization&#58;</span> 5 during follow-up to assess sustained response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Significant improvement and greater patient satisfaction for the combined treatment over the control treatment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;011 and &#46;048&#44; respectively&#41;&#46; PGA evaluation of response to treatment showed absence of recurrence in 55&#37; of the intervention sides &#40;combined treatment&#41; vs 35&#37; on the control sides&#46; Histology of the skin 2 wk after the last session revealed a scant perifollicular lymphohistiocytic infiltrate on the combined-treatment side&#46; Less decrease in the infiltrate and in dermal edema on the Nd&#58;YAG-only side&#46; No adverse effects other than erythema&#44; which resolved spontaneously by 48<span class="elsevierStyleHsp" style=""></span>h&#46;<span class="elsevierStyleItalic">Adverse effects&#58;</span> 1 patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Combined fractional CO<span class="elsevierStyleInf">2</span> and long-pulse &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; Nd&#58;YAG laser therapy achieves greater improvement and patient satisfaction and lower recurrence rates in comparison with Nd&#58;YAG therapy alone for HS in Hurley stages 1 and 2&#46; Combined therapy could achieve better results in patients with low PGA scores who are not obese and have not undergone prior surgery at the site of a lesion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limitations&#44; a small sample size and short follow-up&#46; RCTs are needed to analyze intraindividual responses in more patients and for longer periods and to compare combined laser therapies to medical and surgical treatments of HS&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional diode laser</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fabbrocini et al&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Design&#58;</span> prospective case series<span class="elsevierStyleItalic">Objective&#58;</span> To evaluate the efficacy of intralesional 1064-nm diode laser treatments in mild-moderate HS&#46;<span class="elsevierStyleItalic">Study period&#58;</span> May 2016&#8211;January 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">No&#46; of patients&#58;</span> 20<span class="elsevierStyleItalic">Characteristics&#58;</span> patients with Hurley stage 1 or 2 HS&#44; mild-moderate according to PGA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diode laser &#40;1064<span class="elsevierStyleHsp" style=""></span>nm&#41; in 300&#8211;600<span class="elsevierStyleHsp" style=""></span>nm<span class="elsevierStyleHsp" style=""></span>polycarbonate-coated glass optical fiber&#46;Fluence&#44; 250<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; fiber diameters varied according to type of lesion and site&#46;Pulse energy&#44; 150&#8211;350<span class="elsevierStyleHsp" style=""></span>ms&#59; selected potency&#44; 6&#8211;8&#8211;10<span class="elsevierStyleHsp" style=""></span>W&#46; A 30-gauge needle was used to inject an anesthetic solution &#40;1<span class="elsevierStyleHsp" style=""></span>mL&#47;cm<span class="elsevierStyleSup">2</span>&#41; until tumescence&#46;On the day of treatments&#44; all patients started azithromycin &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;d for 3 d&#41;&#46;4 treatment sessions&#44; 2-wk intervals&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Each patient underwent 4 laser sessions at 2-wk intervals&#46; Significant reduction &#40;31&#37;&#41; in the Sartorius score from 28&#46;55 &#40;13&#46;04&#41; to 19&#46;75 &#40;12&#46;29&#41; after 4 sessions &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; No patient worsened&#46;Quality of life improved notably along with clinical improvement &#40;reduction in DLQI scores &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0307&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intralesional 1064-nm diode laser treatment may be a good alternative for patients with moderate&#44; localized HS&#44; given it is minimally invasive and does not have significant complications&#46; Recovery is rapid&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Few patients&#44; low quality of evidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Photodynamic therapy with intralesional methylene blue and a 635 nm light-emitting diode lamp in hidradenitis suppurativa&#58; A retrospective follow-up study in 7 patients and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Agut-Busquet"
                            1 => "J&#46; Roman&#237;"
                            2 => "Y&#46; Gilaberte"
                            3 => "A&#46; Garc&#237;a-Malinis"
                            4 => "M&#46; Ribera-Pibernat"
                            5 => "J&#46; Luelmo"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1039/c6pp00082g"
                      "Revista" => array:6 [
                        "tituloSerie" => "Photochem Photobiol Sci&#46;"
                        "fecha" => "2016"
                        "volumen" => "15"
                        "paginaInicial" => "1020"
                        "paginaFinal" => "1028"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27417568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efectividad de la terapia fotodin&#225;mica con &#225;cido 5-aminolevul&#237;nico en el tratamiento de la hidrosadenitis supurativa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Andino Navarrete"
                            1 => "A&#46; Hasson Nisis"
                            2 => "J&#46; Parra Cares"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Serie de 5 casos&#46; Actas Dermosifiliogr&#46;"
                        "fecha" => "2014"
                        "volumen" => "105"
                        "paginaInicial" => "614"
                        "paginaFinal" => "617"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interventions for hidradenitis suppurativa &#40;Review&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Ingram"
                            1 => "P&#46;N&#46; Woo"
                            2 => "S&#46;L&#46; Chua"
                            3 => "A&#46;D&#46; Ormerod"
                            4 => "N&#46; Desai"
                            5 => "A&#46;C&#46; Kai"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Cochrane Database Syst Rev&#46;"
                        "fecha" => "2015"
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                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Hidrosadenitis supurativa y procesos afines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;I&#46; Herane"
                            1 => "R&#46; Alarc&#243;n"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "M&#225;s dermatolog&#237;a&#46;"
                        "fecha" => "2012"
                        "paginaInicial" => "4"
                        "paginaFinal" => "12"
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                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en hidrosadenitis supurativa en Atenci&#243;n Primaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Garc&#237;a-Mart&#237;nez"
                            1 => "J&#46;C&#46; Pascual"
                            2 => "I&#46; L&#243;pez-Mart&#237;n"
                            3 => "J&#46;J&#46; Pereyra-Rodr&#237;guez"
                            4 => "A&#46; Martorell Calatayud"
                            5 => "L&#46; Salgado-Boquete"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "volumen" => "43"
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0030"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en hidradenitis supurativa &#40;I&#41;&#58; epidemiolog&#237;a&#44; aspectos cl&#237;nicos y definici&#243;n de severidad de la enfermedad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Martorell"
                            1 => "F&#46;J&#46; Garc&#237;a-mart&#237;nez"
                            2 => "D&#46; Jim&#233;nez-gallo"
                            3 => "J&#46;C&#46; Pascual"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2015.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
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                        "paginaFinal" => "715"
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                          0 => array:2 [
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy&#58; Off-label and alternative use in dermatological practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            1 => "M&#46; Troiano"
                            2 => "R&#46; Rossi"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pdpdt.2008.03.001"
                      "Revista" => array:6 [
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                        "volumen" => "5"
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              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
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        "texto" => "<p id="par0345" class="elsevierStylePara elsevierViewall">We thank Ms Visitaci&#243;n Ortega Riba and Ms Montserrat Salas Valera for their help with the systematic literature review and downloading of articles&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">We are also grateful to the Government of the Spanish Autonomous Community of Aragon for their recognition of our research group &#40;reference number B18&#95;17D&#41;&#46;</p>"
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ISSN: 15782190
Original language: English
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