Laser Hair Removal as Pilonidal Treatment


Staff member
Successful treatment of recurrent pilonidal sinus with laser epilation.
Dermatologic Surgery, June 2005

Landa N, Aller O, Landa-Gundin N, Torrontegui J, Azpiazu JL.

Dermitek Clinic of Laser, Dermatology and Aesthetic Surgery, Bilbao, Basque Country, Spain.

BACKGROUND: Pilonidal disease is a chronic disease of the natal cleft. Recurrent follicular infection is the causative factor. Surgical treatment has a significant failure rate, and recurrence is common. Laser removal of hair in the natal cleft could be an alternative to surgery. OBJECTIVE: To determine the effectiveness of laser hair removal in the natal cleft on pilonidal disease. METHODS: Six young men with recurrent pilonidal disease were treated with laser epilation in our clinic from 2000 to 2003. Most patients had a history of one or more surgical treatments in the area, and all patients had suffered recurrent folliculitis for years. An alexandrite laser was mostly used, although, occasionally, an intense pulsed light device was used. The number of epilation treatments ranged from 3 to 11, performed at 6- to 8-week intervals. RESULTS: All patients experienced progressive resolution of the folliculitis with the laser epilation treatments. No more surgical treatments have been needed. The treatments were simple and quick, and there were no complications. CONCLUSION: Laser epilation of the natal cleft should be considered a first choice treatment for recurrent pilonidal disease. Preventive laser epilation of the natal cleft in patients with recurrent folliculitis could avoid future surgery.

I'd also like to know what Dr. Bascom thinks about laser treatment.... And even though I have been told no before, I now have reason to inquire again about laser treatment...(I was previously told that laser treatment only works on light/fair skin colors).

Usually I love my browner skin tone...but now it's a disadvantage! lol...
So, this stops the cyst by removing the infected hair? I don't understand how this removes the actual cyst or sinus. But then again I'm not a doctor, lol.
I think hair removal doesn't remove the cyst, but stops the infection that is caused by hairs continually getting sucked into the sinus and infecting it. Once you remove the hairs around your crack the cyst stops getting infected and just turns into a little lump that doesnt drain and isnt painful. This is what I found happened after a few months of shaving the area daily (I haven't had laser treatment tho).
Interesting, I was considering getting this done anyway and have not had surgery yet. I would wonder what damage or irritation the light pulses the macines send out could do to the cyst and possibly increase its size or infect it.

In addition most lasers target the dark pigment in the hair and are concentrated well below the start of the hair follicule. When activated , the laser scortches the follicle because the light emitted is concentrated on the pigment and the hairs migrate to the surface and eventually fall out. If one had a mass of hair located in a channel below the skin, I would think the trauma of that much hair getting scortched at once may cause something to rupture or become infected. This is however my own thinking and I have no knowledge on the matter except from what they explained to me at the laser clinic and what ive read online here.
Lasers and Pilonidal

I have been using lasers since 1988 and on hair removal since the late 1990s. It works, but like everything else it is not for all. Light haired patients and those with dark skin (e.g.blacks) do not respond well. Others can be helped, although lasers will not treat the pilonidal per se. I have found them to be most useful in preventing some recurrences because they prevent the regrowth of hair.

Hair grows in 3 stages. You have to treat the active stage to kill the follicle. That is why several treatments are required and you must be persistant. Miss a couple of sessions and you have to start all over again.

The insurance companies are a problem here. They insist that what I am doing is cosmetic surgery (so they don't have to pay). They have never been avle to tell me why it is cosmetic rather than therapeutic, but there is always a fight when I offer this to a patient. These guys can't figure out that this treatment is a lot cheaper to cover than to pay for multiple recurrences. I guess that is why you never see a poor insurance company!
ZapRowsdower;49118 said:
Is reoccurance really that common? I'd hate to think all the crap I went through a year and a half ago was for nothing.
We don't have all the answers yet. Just using the "pit picking" eliminates 30% of the problem. The Bascom cleft shift eliminates most of the rest. Lasers can help, but you have to have some one who knows how to do it.

Hmmm. How exactly do they go about lasering an area with a sinus that is draining? I would think lasering an open wound would be bad, no?
JohnG;50398 said:
Hmmm. How exactly do they go about lasering an area with a sinus that is draining? I would think lasering an open wound would be bad, no?
You dont' "laser" the open wound. The wound is treated as any other wound and the pilonidal is treated in one of several ways. I personally prefer the pit picking and drainage. If hair along the "rim trails" of the natal cleft start to become a problem, then laser hair removal, in my opinion, is indicated to try to prevent a recurrence without resorting to surgery. Sometimes surgery is indicated, but the laser is a useful tool to keep in mind.

irishdoc;50264 said:
We don't have all the answers yet. Just using the "pit picking" eliminates 30% of the problem. The Bascom cleft shift eliminates most of the rest. Lasers can help, but you have to have some one who knows how to do it.

Which one is which? I'm pretty sure I got the second one. I remember them taking a pretty good sized chunk out of the area.
I would recommend to anyone with Pilonidal, to opt for laser hair removal FIRST. From what I have read, it will cure some cases (with antibiotics also). However, it you do still require surgery, it is VERY beneficial to have already had the laser hair removal because hair in the open wounds is a big reason the pilonidal recurrences. I am not a doctor, however this is my observation from reading many sites and seeing my own son's pilonidal return. he has had 5 surgeries (1 marsupulization, followed by 2 cleft surgeries followed by 2 marsupulizations including connection to an anal fistula that was most likely man made in a previous surgery). His condition is AGAIN coming back in part because there is so much hair in that area, the wound does not want to heal. It is almost impossible for him to get laser hair removal now because he continually has an open wound. So I REALLY regret having surgery BEFORE hair removal. My advice - avoid surgery until no other options work. Best wishes
@Mom of PC son
After reading about your son, I am a bit skeptical for Cleft Lift Procedure. I am due for the surgery in Feb 2017. I've already started LASER Hair Removal few months ago. I will live with it but I won't go do multiple surgeries and make the area worst.
Cleft Lift works in some cases, but any surgery should be last resort after laser hair removal, clensing with antibacterial soap and any other home type remedies. We never intended to do this many surgeries either but once we started we had no choice. We went to 3 different hospitals and the doctors were always so sure they were going to cure him. keep in mind, recurrence is not the most common outcome. Many people are cured, but most people that come to these sites are desperate after failed attempts. You are on the right track. Stick to the non surgical remedies and hopefully you will be healed without surgery like many others have been cured.
@Mom of PC son
My prayers and wishes are with you and your family. I hope your son heals fast and gets back to his regular life soon. wonder what kind of doctors you visited? did you tried the doctors listed at this website who do clift lift? I will recommend you read this website lots of valuable info. I have completed 4 sessions and 5 sessions are remaining 10 weeks apart for LASER Hair @ Ideal Image. I started using Hibiclens recently for skin cleansing. From Last 6-8 Months I wasn't lucky to have insurance so I drain the cyst at home after warm bath. During my last visit on Jan 3rd 2017 at Wu-physicians here in St.Louis doctor gave me few options Lancing or Cleft Lift, I am thinking to delay the surgery for few more months. I already had lancing in the past with no help so that's not the option anymore.

I have a very small cyst and some doctors think it's a candidate for cleft lift and some think it's not pilonidal as I don't have any pits. I think I have pilonidal since it had all the effects of pilonidal cyst mention on this website.
Yes it does sound a lot like Pilonidal from what you have said. It is a tough decision and eventually surgery may be the best solution. If it is small and you can put up with the pain, I would still wait before surgery. The other thing you might consider if you have not already is to get an antibiotic like augmentin. I heard from one doctor that after World War II tens of thousands of soldiers had this disease and 40% of them were cured with only shaving and antibiotics. Topical antibiotic has helped his open wound heal (like metronidazole) but may also help keep it from causing infection from the outside. The thing is, even if you have to have surgery, it will be very beneficial to have already had the laser hair removal so that the open wound does not continue to get hair in it. If you do a cleft procedure, be sure to get laser hair removal from most if not all of your butt cheek area because they will remove a strip of skin in the center and you will have stitched areas that again have hair on them. My son had a few sessions of laser treatment along the few inches in the center (cleft area), but that skin was all removed during surgery. He developed pilonidal again in the center in new skin that was previously off to the side. We live in the Dayton OH area. Our first Dr. was at Dayton Childrens (plastic surgeon did marsupulasation, then a team of two Drs. (one plastic surgeon and one colo-rectal) at OSU did the first cleft procuredure. They were certain it would heal it because they had been doing 10 a year with no failures. He had a spot that didn't heal, so they went in to do a EUA (evaluation under anesthesia) and came out to tell us they had completely re-done the cleft procedure because it had tracked completely under the first one. Then about 3 weeks later, the colorectal surgeon did another marsupulasation at the very bottom because it was starting to come back again right away. That is when he put a seton in his anus because he found an anal fistula which we thought might be connected but actually now doesn't look like it was. Still healing now from the 5th surgery at the Cleveland Clinic where the colorectal surgeon removed the seton and connected the anal fistula area with the pilonidal area. Very rare case but hopefully he will heal up, then get the laser treatments and be able to get on with his life. Be patient with the laser treatments if you can. Thanks for your prayers and we will keep you (and all the other pilo patients) in ours!!!