Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study.
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INTRODUCTION: Pilonidal disease is a chronic skin disorder of the gluteal cleft in adolescents and young adults. No treatment is universally effective, and the heterogeneity of the disease and variability in treatment response frustrates patients and clinicians alike. Surgical treatment strategies focus on the removal of the sinus tracts. Post-operative laser hair removal (LHR) has demonstrated promise to reduce disease recurrence following surgery. LHR has yet to be investigated as a primary treatment strategy and may offer additional benefits. METHODS: A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease. Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited. Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met. Patients with persistent symptoms after LHR underwent subsequent excision. Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence. Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection. Secondary outcomes included the number of episodes of infection and impact on quality of life, as assessed by the Dermatology Life Quality Index (DLQI) in patients ≥16 years of age, and the Children's Dermatology Life Quality Index (CDLQI) in patients <16 years of age. RESULTS: Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study, designed to the endpoint of the absence of terminal hair in the gluteal cleft. One patient withdrew prior to completion of the LHR sessions, and two withdrew from the study due to the COVID-19 pandemic. Of the 15 patients who completed the LHR sessions, all demonstrated significant improvement in hair follicle density in the treatment area, with no adverse events. Median number of laser treatments was 6. Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence. Quality of life scores improved after laser treatments (DLQI mean change -4.6, and Children's DLQI mean change -6.0) CONCLUSION: Laser hair removal was well tolerated, without adverse events and with improved quality of life, in a patient population with moderate to severe pilonidal disease. Nearly half of patients had disease resolution without the need for surgical intervention. These findings underscore the potential for laser hair removal to improve disease outcomes in pilonidal disease, reducing the need for surgical intervention. Based on these results, laser hair removal might provide an effective primary treatment strategy for some patients, and could improve outcomes for those who require surgical intervention. Further research is needed to determine which patients would most likely benefit from this treatment strategy. LEVEL OF EVIDENCE: Level III.