Pilonidal Sinus and Hair Removal
In my first year as an electrologist I had a client come to me and ask if I could treat her 18 year old son that was afflicted with a Pilonidal Cyst. My first thought was “what on earth is Pilonidal Cyst?” I was frantically searching my mind trying to remember if I had learned anything about this debilitating disease in my training. The answer was a big fat NO. I approached my then mentor and asked her. She was as perplexed as I was. She had been in the industry for over 25 years at the time… Here is what I learned.
A Pilonidal Cyst or Sinus is a nasty abscess in the midline of your bum created from an infected hair follicle. It usually develops in the cleft of the buttocks where the buttocks separate. More than one hole may develop, and often these are linked by tunnels under the skin.
The exact cause of a Pilonidal Sinus is unclear, although it is thought to be caused by loose hairs piercing the skin. The term “pilonidal” is Latin for “nest of hairs”. Crazy that a bunch of hairs can cause such a “pain in the butt”!
Certain factors can increase your chances of developing a Pilonidal Sinus, such as being obese, having a large amount of body hair and having a job that involves a lot of sitting or driving, sometimes known as “Jeep seat”.
Pilonidal Sinus rarely goes away on its own. Most require some form of surgical intervention, although there are cases of “disappearance” after lancing or antibiotic treatment.
It’s important to note that not all cases of Pilonidal Sinus is caused by an ingrown hair. Approximately 50% of sufferers are found to have no hair in their Pilonidal Abscess (most frequently the case in females).
Hair can play a role in Pilonidal Disease, but the real culprit is an expanded/exploded follicle called a “pit” in the midline of the buttock cleft.
A Pilonidal Cyst is basically an abscess beneath the skin – a boil gone very, very bad. Pilonidal abscess are prone to excruciatingly painful infections and they can expand and form additional sinuses.
To prevent recurrences, it is advised to remove as much hair as possible in the affected area and to keep the affected area clean of any debris.
- Hair Removal: Most surgeons recommend hair removal during healing and for a few months after surgery. Long term hair removal is a decision for you to make with your doctor. Who imagined that one day removing hair from your butt crack would become part of your regular grooming routine? One thing that many experts agree on is that those people prone to Pilonidal Sinus need to make every reasonable attempt to keep the cleft free from hair and debris. This surgery frequently requires a long recovery period with post-op vacuum cleansing of the open wound. It is quite painful and debilitating; treatment options for avoiding subsequent surgeries are well worth the time and money. There are many different hair removal methods and although electrolysis is the only permanent hair removal methods in this case we need to look at laser hair reduction as well.
- Electrolysis : Is the only permanent hair removal method approved by the FDA. Electrolysis is considered to be very effective as it cauterizes the source of nourishment, which result’s in a dead hair follicle. Removing the hair might not cure the chronically infected cavities but it will reduce the chances of reoccurrences. It is recommended to remove about 3 inches all around the affected area as it helps to exfoliate the skin as well and keep area clean. This is a good thing for people prone to Pilonodal Sinus since blocked hair follicles are also a cause of the disease. There are convincing case reports showing that permanent hair removal before surgery will decrease an already high recurrence rate following surgery. The cost for electrolysis treatment is anywhere from $50 to $120 per hour.
- Laser hair reduction using a YAG or IPL: Laser hair removal has shown promises at reducing recurrence of Pilonodal Disease post-surgery. Laser might be worth the expense of $100 to $250 per treatment. It usually takes 6 to 8 treatments and 4 to 6 weeks apart to eliminate 85% of the hairs and the hair follicles that produce each hair shaft. That’s because laser and IPL treatments only kill the cells within the hair follicles that are in the “growing phase” of a three-phase cycle. Each hair follicle contains thousands of cells and only 20% to 30% of these cells are in this growing phase at any one time each month. 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%.
The best approach to alleviate any recurrences of Pilonidal Sinus is to remove all unwanted hair within three inches in all directions of the drainage sinuses BEFORE undergoing surgical excision of the Pilonidal Cysts and/or abscess cavities.
Dr Nolan Hetz
Pilonidal Support Alliance