Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults

Abstract

ImportanceRecurrence continues to be a significant challenge in the treatment and management of pilonidal disease.ObjectiveTo compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults.Design, Setting, and ParticipantsThis was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children’s hospital.InterventionLE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone.Main Outcomes and MeasuresThe primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications.ResultsA total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (−23.2%; 95% CI, −33.2 to −13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications.Conclusions and RelevanceLE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03276065

Preventing Pilonidal Sinus Recurrence With Laser Hair Epilation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…An inverse variance function was implemented to account for heterogeneity. The prospective RCT conducted by Minecci et al [9] involved a total of 302 participants, comprising adolescents and young adults aged between 12 and 21 years with a diagnosis of PSD. Patients with an actively inflamed pilonidal sinus and a history of photosensitivity were excluded from the study.…”

Efficacy of laser hair removal in hidradenitis suppurativa: A systematic review and meta‐analysis

“…Further studies are needed to determine if timing of LHR intervention is critical, specifically if early treatment with LHR during the prepuberty stage, at the onset of pubarche or shortly after, may prevent HS development in patients with a strong family history and/or other risk factors. LHR has been used successfully and safely in pediatric and adolescent patients with pilonidal disease, [46][47][48][49][50][51] but future studies are needed to assess the efficacy and safety of LHR in pediatric and adolescent HS patients. Furthermore, LHR may be considered an early treatment in HS patients to prevent progression to late-stage disease, halting the disease process at an earlier stage.…”

Analysis of the Laser Epilation in Pilonidal Disease Trial—Reply

“…In Reply We appreciate the comments from Mei and colleagues regarding the potential effects of the COVID-19 pandemic and differences in follow-up and compliance on recurrence rates in our trial …”

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COMMENT & RESPONSEIn Reply We appreciate the comments from Mei and colleagues regarding the potential effects of the COVID-19 pandemic and differences in follow-up and compliance on recurrence rates in our trial. 1 The COVID-19 pandemic caused a period during which we were unable to perform LE and led to 15 patients in the LE group withdrawing from the study due to COVID-19-related concerns about the risks associated with hospital visits for treatments. After consultation with the study statistician, data safety monitoring committee, and funding agency, an additional 15 patients were enrolled in each group to maintain the required study power.

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