Pilonidal Hair Removal

Long-term hair removal is debated. Most surgeons recommend keeping the surgical area free of hair during healing and for a few months after surgery, but few patients maintain this for the long term. Some studies show that long-term shaving increases the risk of recurrence. However, keeping the midline free of hair certainly helps reduce future risk, so consider laser hair removal if your insurer will cover it.

Laser Hair Removal

Laser hair removal has shown promise in reducing the recurrence of pilonidal disease after surgery. Typically, health insurers see it as cosmetic, so you and your doctor may need to justify its medical necessity to prevent recurrence. Dr. Paul Harper reports success with laser hair removal as aftercare, but notes that getting insurance coverage can be hard.

Laser Hair Removal Study

Laser Hair Removal as Adjunct to Surgery for Pilonidal Sinus: Our Initial Experience

Laser Hair Removal as Adjunct to Surgery for Pilonidal Sinus: Our Initial Experience

Journal of Cutaneous and Aesthetic Surgery: Sept-Dec 2011 pp192-195

Wagih Mommtaz Ghnnam1 and Dhafer Mohmmed Hafez

Abstract

BACKGROUND: This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal.This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal.

METHODS: Patients undergoing surgery for pilonidal disease were randomized to two groups: those using laser hair removal methods following completed healing of wounds (group I) or regular post-healing conventional methods for hair removal, mainly razor and depilatory creams, for at least 6 months (group II). Group I patients received regular, monthly laser hair treatment sessions using Alexandrite laser for four sessions at monthly intervals . The Alexandrite laser has a wavelength of 755 nm, and was used at a fluence of 14–16 J/cm2 and fixed pulse duration of 3 ms, with spot size of 15 mm. The light (pulses) was delivered at 1 pulse/s, allowing large areas to be treated rapidly (we call it frequency)

RESULTS: After a mean follow up of 2 years, Group I (laser hair removal group) had an overall recurrence rate of 2.3%. Group II (razor shaving group) had a recurrence rate of 17.1%.

CONCLUSIONS: In this study, the recurrence rates for surgical intervention were found to be comparable with the results of previous studies, but our results strongly suggest that laser hair removal after surgical interventions in pilonidal sinus disease decreases the risk of recurrence in the long term. Laser epilation is simple and quick, without any complications. We recommend laser epilation to every patient with pilonidal sinus disease as an adjunct treatment after the surgical intervention to prevent further surgery.

Read the full study at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263130

Shaving

A study in 2009 concluded that shaving was associated with an increased chance of recurrence – we post the abstract from this study:

Study Findings

Term Effects of Postoperative Razor Epilation in Pilonidal Sinus Disease

Diseases of the Colon & Rectum: January 2009-Volume 52-Issue 1-pp131-134

Petersen, Sven M.D., Ph.D.

Abstract

PURPOSE: To study potential benefits of postoperative epilation after pilonidal sinus surgery, the long-term effect of hair removal on pilonidal recurrence was investigated.

METHODS: A total of 1,960 patients with pilonidal sinus treated surgically from 1980 to 1996 in three hospitals of the Deutsche Bundeswehr were eligible for the study. Regular hair removal with a razor was recommended for all patients after surgery. A randomly selected sample of 504 patients was contacted for a follow-up telephone interview.

RESULTS: The mean follow-up time was 11.3 (standard deviation, 6.4) years. Overall, pilonidal sinus disease recurred in 111 (22 percent) of the 504 patients. A total of 113 patients followed the recommendation to perform epilation (mean duration, 7.5 months), and 391 patients did not. Recurrence was observed in 30.1 percent (34/113) of patients who performed postoperative epilation and in 19.7 percent (77/391) of patients who did not perform postoperative epilation (P = 0.01).

CONCLUSIONS: Razor hair removal increases the rate of long-term recurrence after surgery for pilonidal sinus disease and therefore should not be recommended. However, the rationale for hair removal in pilonidal sinus disease is compelling. Other epilation techniques such as laser hair removal should be investigated in appropriate studies

One Woman’s Tour of Hair Removal Hell

Just in case you do decide to proceed with hair removal, here is a tour of the options:

Shaving, blade: Blade shaving is traditional, but tough on tender skin and difficult to do alone on this part of the body. It often causes nicks, cuts, and razor burn.
Shaving, electric: Electric shavers (“groomers”) are gentler and easier to use on the natal cleft. These cost $15–$20 and are available online or at drugstores.
Waxing: Waxing lasts up to 3 weeks and isn’t extremely painful, but it’s hard to do solo. Professional waxing is nothing new for salons—don’t be shy. Waxing can inflame treated skin, so check with your surgeon and use No Bump RX to prevent ingrown hairs. Don’t wax near open wounds.
Depilatories: Some doctors recommend these, but few patients stick with them. Depilatories are smelly, can irritate skin, and should never be used near open wounds. Use with caution.
Electrolysis: Expensive and painful, but effective and permanent. It causes inflammation but kills the follicle. We haven’t heard from anyone who’s tried electrolysis in the natal cleft yet.
Vaniqa / Eflora: Creams that slow hair growth (mainly for facial hair). About 58% of users see results. Vaniqa is prescription-only, but Eflora is available over the counter. They thin hair, but don’t remove it. They don’t get rid of the hair, but make it grow slower and finer. Vaniqa is a prescription-only product, but it appears you can buy Eflora over the counter (same ingredients, just generic). I’ve seen lots of positive reviews of both products, but not on any sites I trust that feature real, impartial users.