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. 2015 Oct 7;2015(10):CD010081. doi: 10.1002/14651858.CD010081.pub2

Tierney 2009.

Methods This was a within‐participant RCT in which 1 side of an anatomical site received the intervention, and the other side received a control topical therapy. 4 laser treatments were given at monthly intervals, followed by a 2‐month observation period
Participants The trial recruited 22 HS participants with moderate to severe disease, as defined by a Hurley grade of II or III. 34 bilaterally affected anatomical sites (axilla/groin/inframammary) were randomised
Interventions Left and right sides of the same anatomical site received either:
  • benzoyl peroxide wash 10% and clindamycin 1% gel or 1% lotion (the frequency was not stated); or

  • Nd:YAG laser treatment on 4 occasions at monthly intervals and topical benzoyl peroxide 10% and clindamycin 1%


Laser treatment settings:
  • Skin types I to III: fluence: 40 to 50 J/cm2, pulse duration: 20 ms, spot size: 10 mm

  • Skin types IV to VI: fluence: 25 to 35 J/cm2, pulse duration: 35 ms, spot size: 10 mm

  • Individual nodules were treated with double pulsing, and the background skin was treated with a single‐pulse technique

Outcomes Primary outcomes
  1. HS‐LASI (Sartorius 2003 scale)

  2. Modified HS‐LASI: HS‐LASI with addition of erythema, oedema, pain, and purulent discharge for each anatomic site


Tierney 2009 reported results 3 months after the first laser treatment, and Mahmoud 2010 (a secondary publication) reported results after a further 2‐month observation period
Secondary outcomes
  1. Participant global assessment measured at the end of the study with an non‐validated questionnaire

Notes Upon discussion with the study authors, we were told that during the first month of the trial, participants received the topical therapy only. At the end of the first month, they received their first laser treatment, and this continued monthly for the next 3 months, administering a total of 4 treatments. Following this, there was a 2‐month observation period with no laser treatment
The authors indicated that there was no support from commercial sponsors. The study was funded in part by an American Society for Dermatologic Surgery Cutting Edge Research Grant and the Shahani Fund. The authors acknowledged support from the Hidradenitis Suppurativa Foundation
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk A coin toss was used
Allocation concealment (selection bias) Low risk A coin toss was used
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Participants and personnel were unblinded
Blinding of outcome assessment (detection bias) 
 All outcomes High risk Detection bias was low risk for investigator‐reported outcomes – "blinded nontreating physician investigators performed scoring evaluations" ‐ but high risk for participant‐reported outcomes
Incomplete outcome data (attrition bias) 
 All outcomes High risk There was no intention‐to‐treat analysis, and 5 participants (23% of total), including 8 anatomical sites (24% of total), dropped out and their results were not included
Selective reporting (reporting bias) Unclear risk The study was registered prospectively on ClinicalTrials.gov, NCT00494351. The primary outcome was stated to be Hidradenitis Severity Score, but both the original Sartorius 2003 score and a version modified by the authors were measured. The timing of primary end points was not stated
Other bias High risk 3 episodes of cellulitis at non‐treatment sites required antibiotic therapy, which may have affected the results

BD: twice daily.
 BMI: body mass index.
 CRP: C‐reactive protein.
 DLQI: Dermatology Life Quality Index.
 EOW: every other week.
 ESR: erythrocyte sedimentation rate.
 GC: gentamicin‐collagen.
 HS: hidradenitis suppurativa.
 HS‐LASI: HS Lesion, Area and Severity Index.
 HS‐PGA: Hidradenitis Suppurativa Physician's Global Assessment.
 HSSI: Hidradenitis Suppurativa Severity Index.
 IPL: intermittent pulsed light.
 ITT: intention‐to‐treat.
 LOCF: last observation carried forward.
 Nd:YAG: neodymium‐doped yttrium aluminium garnet. 
 PC: primary closure
 PDT: photodynamic therapy.
 PGA: Physician Global Assessment.
 RCT: randomised controlled trial.
 S. aureus: Staphylococcus aureus. 
 S/c: subcutaneous.
 TWPI: Total Work Productivity Impairment.
 VAS: visual analogue scale.