One of the tough realities about hidradenitis suppurativa is that wherever you have hair, you can have symptoms flare. The lumps and fluid-filled bumps associated with the skin condition often show up in places where thicker, coarse hair grows—namely, your armpit and groin. Experts believe HS starts in your follicles—a.k.a. the tubelike structures that hair sprouts from. These can become inflamed, leading to blockages that subsequently evolve into painful pus-filled boils, abscesses, and often scars.
While people often think of laser hair removal—which works by heating up and permanently damaging follicles—as a strictly cosmetic procedure for folks who don’t want to wax or shave, it can also be used to prevent symptom flares if you have HS. Sounds great, right? There are, however, some big caveats: It’s expensive and probably won’t be covered by insurance. It may not work. And if you have darker skin, you’ll need to take special care that your laser hair removal is done safely. Here’s a breakdown of what you should know before trying it.
How lasers can be used to treat HS
“I routinely recommend medical laser hair reduction for people with hidradenitis suppurativa, and it can be very beneficial when recommended for patients appropriately,” Oma Agbai, MD, an associate clinical professor of dermatology at the University of California, Davis, tells SELF. The people who are most likely to benefit are those with mild to moderate HS who still have symptoms even though they are taking medication, she says. (If you have severe HS, it may be too painful to even try—more on that later.)
Makayla Humphrey, a 25-year-old from Texas, used to have disabling HS flares in her groin area—including abscesses the size of “golf balls.” “They would get so bad, I couldn’t walk,” Humphrey tells SELF. After having laser hair removal, they didn’t go away completely—she had a flare on her bikini line just recently, six months after her last treatment—but it was nowhere near as bad as it was before. “It was small and went away on its own,” Humphrey says.
Flares will still happen after laser hair removal, Onyeka Obioha-Lolagne, MD, a board-certified dermatologist in Beverly Hills, tells SELF, because HS is a complex inflammatory condition without an easy fix. However, according to a review of existing research published in 2020, laser hair removal reduced HS symptoms—lumps, boils, and abscesses, as well as problems like rash and pain—by anywhere from 32 to 73%.1 The likelihood of success varied with the type of laser (more on that later), the body area treated, and the number of sessions.
“Laser hair removal does not get you out of the woods,” Dr. Obioha-Lolagne says. But, she adds, for some people, it can be a “great complement” to other therapies.
What to know if you have dark skin
Black and biracial people in the US are two to three times as likely to have HS as white people.2 The thing about lasers is, they haven’t always worked that well for people with darker skin. For a long time, laser hair removal was really only an option for people with light skin and dark hair. (Without that color contrast, older lasers could not distinguish hair follicles from skin. That meant the treatment was not only ineffective but carried a serious burn risk for people of color.)
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Fortunately, Dr. Obioha-Lolagne says the technology has gotten much better. One newer laser that can be a good option for dark skin is the Nd:YAG, per the Skin of Color Society. (This is a type of laser, not a brand name, and the “long pulsed Nd:YAG,” which has a 1064 nanometer wavelength, is considered the best to use.) There’s also quite a bit of research showing that these lasers work well for people with HS.1
Dr. Agbai says they are her go-to for treating people with dark skin, and she makes sure to use the laser’s “conservative settings.” It’s critical, she stresses, that you get the procedure done by someone who knows what they are doing. “One laser may be safe and effective on fair skin, while the same laser might induce hyperpigmentation (dark spots) and scarring on dark skin,” Dr. Agbai says.
This type of laser hair removal is widely available at med spas, which are clinics that offer non-surgical cosmetic treatments under the supervision of a licensed doctor. But Dr. Obioha-Lolagne recommends caution—particularly if you are a Black or brown person.
The “ideal,” she says, would be to see a board-certified dermatologist with expertise in not just laser hair removal for people of color, but also those with HS. Finding a provider who checks all those boxes could be tough. At a minimum, Dr. Obioha-Lolagne suggests seeing a derm comfortable with laser procedures for people of “all skin tones.” (Because a lot of docs may say they are, you may want to take it a step further and ask if it’s possible to see any before and after pics of other patients with HS or talk to people you know for recommendations.)
Even with the correct laser in the right hands, this type of hair removal can still cause irritation, skin color changes, or swelling that lasts a few days. And it can still aggravate HS symptoms in some people, according to the advocacy group HSConnect.
Humphrey, who is a person of color, actually did receive laser hair removal at a med spa—but not until she had a consultation where they discussed her HS symptoms and she confirmed they had experience treating people with the condition. Assured, she decided to take the plunge. Over a series of sessions (10 in all, over the course of roughly a year), Humphrey had both armpits treated, plus her entire pubic area—all done with an Nd:YAG laser.
“It definitely hurts,” she says. The laser pulses are often likened to a rubber band snapping against the skin, but for Humphrey, it was worse—“maybe four rubber bands,” as she describes in this YouTube video detailing her experience.
Still, Humphrey tells SELF, the time on the table was the roughest part. Any skin irritation or pain was gone by the next day. And her HS flares quickly became less frequent and less severe during her treatment course.
What else to know about laser hair removal
As we mentioned, this kind of treatment doesn’t always work, so talk it over with your doctor. Here are some other things to consider when you are deciding whether to try it.
1. You may not be a candidate.
As Dr. Agbai mentioned, this therapy might be a good option for some people with mild to moderate HS (Hurley stage one or two). If you have severe (stage three) HS, she says, the procedure would likely be too painful due to the extent of your skin symptoms. Another word of caution: Laser hair removal should never be done in areas with open wounds. “You never want to treat open skin due to the risk of burns,” Dr. Obioha-Lolagne stresses.
2. It takes time.
Laser hair removal is not one-and-done. To make sure you get all the hair, you generally need several sessions, per the American Academy of Dermatology—often six or more, with about six weeks between each one. Even after all that, it may take time to see improvements in HS flares.
3. You might have to repeat the entire process.
Even if everything goes well, you are unlikely to end up with permanently hair-free skin: The results can last for years for some people, but a more typical time frame is several months. (For her part, Humphrey says she’s already had hair regrowth.) More importantly, it’s not clear how long the benefits for HS flares might last. The studies described above were short-term, following patients over a matter of months, not years, and they didn’t look at repeat treatment courses. And researchers don’t know yet whether getting laser hair removal in the mild stage of HS can help prevent it from getting worse.1
4. It can be pricey.
Laser hair removal is expensive—and you should expect to foot the bill. Even when performed to help with HS, it’s considered a cosmetic procedure, and therefore not covered by insurance. A recent study found that no private insurers listed HS as a covered indication for laser hair removal.3 That’s a big problem for a lot of people, considering the average cost of the procedure—which ranges from $2,300 to $3,900 for 6 to 10 sessions. As frustrating as that is, you should know that some researchers are pointing out that insurance really should cover these sessions.4
For Humphrey, the expense, time, and discomfort has been worth it so far. She says that if her HS flares were to get worse in the future, she’d do it all again. She has nothing against the hair, she says: “I just want to feel okay in my body.”
Related:
- 7 Questions to Ask Your Doctor After Being Diagnosed With Hidradenitis Suppurativa
- Why You Should Never Squeeze or Pop an HS Cyst
- 5 Ways Pregnancy Can Affect Hidradenitis Suppurativa (or Vice Versa)
Sources:
- Frontiers in Medicine, The Efficacy and Effectiveness of Non-ablative Light-Based Devices in Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis
- JAMA Dermatology, Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States
- Journal of the American Academy of Dermatology Research Letter, Insurance Coverage Among the Largest Insurers per State for Laser Hair Removal in the Treatment of Hidradenitis Suppurativa
- Dermatologic Online Journal, Laser Hair Reduction for Hidradenitis Suppurativa Warrants Insurance Coverage
