Background: The chronic fistulating lesions of hidradenitis suppurativa spread by contiguous growth, and all affected tissue needs to be surgically removed. Objective: The aim of our study was to evaluate a surgical method for treatment of Hurley stage II hidradenitis suppurativa (HS), the carbon dioxide laser rapid-beam optomechanical scanner system in continuous mode. Methods: Thirty-four patients were evaluated after treatment; 31 patients were women, and the mean age was 33.9 years (range, 15-55 years). All patients had had HS for a mean of 13.4 years (range 1-35 years) and more than 3 recurrences of suppurating lesions in the year before inclusion in the study. All lesions had been classified as Hurley stage II. The mean follow-up time after carbon dioxide laser surgery was 34.5 months (range, 7-87 months), and patients were later contacted by telephone about recurrences and the end results. Results: The mean healing time was about 4 weeks (range, 3-5 weeks). During follow-up, 4 of the 34 patients had recurrences at the surgical site, that is, locoregional HS. Thirty had no recurrences in the treated area, but in 12 cases de novo suppurating lesions, separated from the initial surgical site by >5 cm, developed. Twenty-five patients had flares of HS lesion(s) in an area other than the treated site. Eight had no recurrences. Conclusion: Macroscopically controlled tissue-selective carbon dioxide laser treatment of HS is a fast, efficient treatment and well accepted by the patients. (J Am Acad Dermatol 2002;47:280-5).