Pilonidal disease is a common condition with reported incidence rates ranging from 26 to 100 per 100 000 withpeak incidence near the end of the second decade of life. Pilonidal disease is an acquireddisease believed to be caused by the insertion of loose hairs into the natal/gluteal cleft, resulting in a chronic foreign body reaction and the formation of epithelialized tracts and midline pits.

Sedentary lifestyle, chronic irritation or chronic trauma/frictional to the area are predisposing factors. It is characterized by intermittent episodes of acute inflammatory flares and quiescent disease, sometimes resulting in the development of chronic wounds and fistulas. The chronicity of pilonidal disease and high recurrence rates contribute to the significant morbidity associated with the disease.

Guidelines for the medical management of pilonidal disease support meticulous hygiene to the sacrococcygeal area and routine hair removal by mechanical or chemical depilation. However, compliance with these recommendations is low, and patients frequently suffer considerable morbidity related to disease recurrence. Due to the paucity of evidence for an optimal treatment approach and lack of a standardized definition for recurrence, there is wide practice variation in management strategies and variability in recurrence rates. Recurrence rates after less invasive measures, including antibiotics and/or incision and drainage, have been reportedto be as high as 30%. Recurrence remains a significant challenge and imposes considerable physical and psychosocial burden in a particularly vulnerable age group. Recurrence rates after surgical excision, considered to be the gold standard treatment for recurrent pilonidal disease, are also high. In addition, patient morbidity after surgical excision is considerable, with a significant percentage of patients suffering from severe wound complications postoperatively. Thus, treatments are clearly needed to prevent the significant morbidity caused by not only the disease, but also the surgical treatments currently available.

Initial conservative management with persistent hygiene, non-epilation hair removal, and lifestyle modification is associated with a reduction in the need for operation. Laser hair reductionis a strategy to decrease pilonidal disease recurrence rates. Several studies have demonstrated the efficacy of laser hair reduction to reduce pilonidal disease recurrence compared to general standard of care in both adults and children.

LHR involves removal of the hair shaft follicle, and bulb via selective thermolysis. Heating of specific target chromophores, such as melanin, results in damage to follicular bulge cells with scattered apoptosis and full-thickness necrosis of the follicles without dissipation to the surrounding tissue.

The success of laser hair reduction to reduce pilonidal disease recurrence may prevent many patients from developing chronic infections and wounds, thereby reducing the number of patients subjected to the significant morbidity of this disease. A less invasive office-based therapy like laser epilation may eradicate the disease entirely and prevent recurrence of pilonidal disease adult patients. LHR as an adjunct to standard care is significantly more effective in reducing pilonidal disease recurrence compared with standard care alone. LHR should be considered a standard treatment modality for patientswith pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients.

References

• Minneci PC, Gil LA, Cooper JN, Asti L, Nishimura L, Lutz CM, Deans KJ. Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial. JAMA Surg. 2024 Jan 1;159(1):19-27. doi: 10.1001/jamasurg.2023.5526. PMID: 37938854; PMCID: PMC10633416.
• Minneci PC, Halleran DR, Lawrence AE, Fischer BA, Cooper JN, Deans KJ. Laser hair depilation for the prevention of disease recurrence in adolescents and young adults with pilonidal disease: study protocol for a randomized controlled trial. Trials. 2018 Nov 1;19(1):599. doi: 10.1186/s13063-018-2987-7. PMID: 30382903; PMCID: PMC6211439.