Carbon Dioxide Laser Treatment Using Methylene Blue–Assisted Sinus Tract Identification in Hidradenitis Suppurativa

Abstract

Keratinocytes and remnant of keratinocytes in nodules, abscesses, and sinus tracts are radically removed in surgical treatment of hidradenitis suppurativa.1 We are now using methylene blue in carbon dioxide laser surgery for patients with moderate to severe hidradenitis lesions (Hurley stage II-III). Methylene blue stains active inflammatory nodules and sinus tracts. We use a modified methylene blue staining technique by the addition of 2% gel of methylcellulose polymers to the dye. The resulting blue gel is easier to handle than a liquid, and is injected or probed into sinus tracts with either a syringe or a cotton swab, resulting in limited dye spillage and a clean operating field. Major tracts are normally easy to probe without staining. However, tracts with hidden orifices and minor branches of epithelialized tracts with diameters too small diameter to probe can be revealed using methylene blue. Figure 1 shows instillation procedure in a sinus tract and uptake of methylene blue gel in lesional skin tissue.