To the Editor:

First we would like to congratulate Dr. Carrascosa and his colleagues for their article “Hidradenitis Suppurativa: New Opportunities for an Orphan Skin Disease“1 on the subject of a disease which, as they indicate, occurs almost always in young patients and has a severely negative impact on the patient's quality of life.

We agree with the opinion expressed in the article that the treatment options for these patients are, in many cases, limited or almost nonexistent. In our hospital we have treated and are currently treating these patients with intralesional photodynamic therapy, with good results.2,3

In a recently published series, we reported the results obtained in 27 patients, as follows: complete response in 37%, good response in 41%, and partial response in 19%.3 In that series, 18 patients underwent a single session of treatment, 7 patients required 2 sessions, and 3 sessions were needed in 1 case. Only 1 of the patients with complete response needed more than 1 session. Tolerance to treatment was good except for 1 patient, in whom treatment was discontinued due to pain. Doppler ultrasound was performed on all the patients before treatment to assess the length and depth of the lesions to be treated. We used the following treatment protocol: 1% 5-aminolevulinate injected at a dose of 0.2mL/cm2; after which, following incubation for 3hours, the lesion was irradiated intratumorally with a laser beam of 630nm (1W/cm2) applied for 3minutes using a fiber-optic probe.3

Although the level of evidence provided by this case series is low (to date we have treated 60 cases), we would like to share the results obtained with this new treatment option for patients with hidradenitis suppurativa who have previously received multiple treatments, including biologic agents; our patients reported marked improvement in quality of life. We feel that it is important to make this brief comment because, once again to paraphrase the authors of the recent article, “even under treatment with these new drugs, however, the response of over half the patients with severe forms of HS will continue to be unsatisfactory.” While it is not, at present, a common technique, the addition of intralesional photodynamic therapy as a therapeutic option for the treatment of HS may be effective in many cases.