Certains patients présentent des infections dans le triangle englobant la zone du sacrum et le pli interfessier. Certaines de ces infections ont pour origine la présence anormale de poils ou simplement leur pousse anormale sous peau. Cette zone étant particulièrement exposée à la prolifération de germes fécaux, ces patients développent fréquemment des infections ou abcès conduisant généralement à des interventions chirurgicales tendant de repérer la cause pour la supprimer. Le suivi post chirurgie comporte des soins de pansement. La récupération de la position assise peut nécessiter quelques jours à cause de la douleur ou simplement de la cicatrisation de la zone opérée. Malheureusement, ces infections sont récidivantes.

Il a été démontré dans 2 études scientifiques en 2005 que le traitement laser (alexandrite, diode ou IPL) des kytes pilonidal permet d’améliorer et de baisser le taux de récidive. IL faut compter, suivant les cas, entre 3 et une douzaine de traitements pour obtenir une amélioration ou un traitement complet des récidives. Le poils traité devient généralement très fin au bout de 2 à 3 séances, ce qui, dans la majorité des cas, est suffisant pour régler le problème d’inflammation/surinfection. Des études ont également démontré que les soins lasers pendant la phase de cicatrisation permettre de raccourcir cette phase.

Successful treatment of recurrent pilonidal sinus with laser epilation.

PMID: 15996432 [PubMed - indexed for MEDLINE]

Dermatol Surg. 2005 Jun;31(6):726-8.Click here to read

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

Dermitek Clinic of Laser, Dermatology and Aesthetic Surgery, Bilbao, Basque Country, Spain. Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

http://www.dermitek.com/noticias/PILONIDALSINUS.pdf

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.

Treatment of pilonidal disease with laser epilation.

Schulze SM, Patel N, Hertzog D, Fares LG 2nd.

Am Surg. 2006 Jun;72(6):534-7

PMID: 16808209 [PubMed - indexed for MEDLINE]

Seton Hall University School of Graduate Medical Education, General Surgical Program at St Francis Medical Center, Trenton, New Jersey, USA.

Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.

Laser epilation is a safe and effective therapy for teenagers with pilonidal disease.

J Pediatr Surg. 2009 Jan;44(1):282-5.

PMID: 19159757 [PubMed - indexed for MEDLINE]

Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C.

Department of General Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

Pilonidal disease (PD) is a frustrating condition because of a recurrence rate as high as 30%. Hair insertion is the essential cause of the disease. Therefore, hair removal with shaving is a part of many postoperative regimens. These methods are resource intensive and adversely impact the life-style of both patient and family. Therefore, we investigated the use of laser epilation (LE) of the intergluteal hair in adolescents with PD as a method of permanent hair removal. METHODS: A retrospective review of all patients with PD who underwent LE from 2003 to 2006 at the National Naval Medical Center, Bethesda, Md, and Walter Reed Army Medical Center, Washington, DC, was performed. Laser epilation of the intergluteal hair was carried out with a 1064 nm Nd:YAG laser (Coolglide Vantage, Altus/Cutera, Brisbane, Calif) at a standard fluence (joule/square centimeter), pulse duration, and repetition rate based on skin phototype. The patients were observed for hair regrowth and recurrence. RESULTS: Twenty-eight teenagers (17 males, 11 females; mean age, 17.2 +/- 1.4 years) underwent LE. Eight patients presented with abscess and were managed by incision and drainage followed by excision and open wound management, 17 patients presented with a cyst or sinus and underwent excision and primary closure, and 3 patients with asymptomatic sinus were managed nonoperatively. Laser epilation was performed after complete wound healing or immediately in those patients with asymptomatic sinus disease. Laser epilation was well tolerated and without complication in all patients. Intergluteal hair was completely removed in all patients. Patients required an average of 5 +/- 2 LE therapy sessions for hair removal. All patients underwent at least 3 LE sessions (range, 3 to 7 sessions) at 4-week intervals. One female developed a recurrence. The mean follow-up for the group was 24.2 +/- 9.9 months. CONCLUSIONS: Laser epilation is a safe method to remove intergluteal hair in teenagers with PD. This technique is an effective adjunctive therapy for the treatment of PD that may reduce recurrence.

Laser depilation of the natal cleft--an aid to healing the pilonidal sinus.

Ann R Coll Surg Engl. 2002 Jan;84(1):29-32.

PMID: 11890622 [PubMed - indexed for MEDLINE]

Odili J, Gault D.

RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, UK. Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

BACKGROUND: Pilonidal disease is common. Excessive hair growth in the natal cleft is thought to be a factor in initiating these sinuses. It is chronic and intermittent in nature and treatment can be difficult. Hair removal by shaving or use of creams is often advised as a compliment to surgical treatments. However, access to the natal cleft can be difficult. Laser removal of hair in the natal cleft is considered as an aid to healing the pilonidal sinus. PATIENTS AND METHODS: Over a 5-year period, 14 patients with recurrent pilonidal disease were treated in our unit with laser depilation. They were all contacted by postal questionnaire, and those with ongoing disease were asked to return to the clinic for evaluation and possible further treatment. RESULTS: All patients returned the postal questionnaire. Of the 14 patients, 4 had on-going disease and received further depilation with the Alexandrite laser. All are now healed with no reported complications. All patients found the procedure painful and received local anaesthetic. CONCLUSIONS: Laser depilation in the natal cleft is by no means a cure for pilonidal disease. Removal of hair by this method represents an alternative and effective method of hair removal and, although long lasting, is only temporary. However, it allows the sinuses to heal rapidly. It is relatively safe, and simple to teach, with few complications. It should thus be considered as an aid to healing the problem pilonidal sinus.

Pilonidal sinus disease treated by depilation using an 800 nm diode laser and review of the literature.

Dermatol Surg. 2005 May;31(5):587-91.

PMID: 15962749 [PubMed - indexed for MEDLINE]

Benedetto AV, Lewis AT.

Dermatologic SurgiCenter, Philadelphia, Pennsylvania, USA. Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

BACKGROUND: Pilonidal sinus disease is a debilitating, disfiguring chronic ailment that is often resistant to therapy. Its etiology and treatment remain in question. OBJECTIVE: To assess the efficacy of an 800 nm diode laser in the treatment of recalcitrant pilonidal sinus disease. METHODS: Two patients with recalcitrant pilonidal sinus disease were treated in the lower back, buttocks, and perigluteal cleft area with an 800 nm diode laser with a spot size of 9 x 9 mm, fluences of 30 to 48 J/cm2, and pulse widths of 15 to 24 milliseconds. RESULTS: Long-term relief of pilonidal sinus disease was produced with as few as two treatments 2 months apart to as many as six treatments over a 2-year period. With each successive treatment, fewer pulses were needed and the interval between treatments increased. CONCLUSION: The 800 nm diode laser may be an effective tool in the treatment of pilonidal sinus disease. By eliminating the source of hair and hair fragments that course along the surface of the lower back and buttocks, interruption of the etiologic source for pilonidal sinus disease can be accomplished.

Recurrent pilonidal sinus treated with epilation using a ruby laser.

J Cosmet Laser Ther. 2002 Jun;4(2):45-7.Click here to read Links

PMID: 12470518 [PubMed - indexed for MEDLINE]

Lavelle M, Jafri Z, Town G.

Princess Royal Hospital, Haywards Heath, UK.

BACKGROUND: Surgical treatment of pilonidal sinus disease of the natal cleft has a significant failure rate. Reported here is the case of a 33-year-old man who first presented at the age of 18 with a pilonidal sinus. METHOD: The patient's scar was treated with a ruby laser using a pulse length of 2 ms and energy densities of 6.0-7.2 J/cm(2). Treatment was performed five times at 6-week intervals. RESULT: The sinus healed and has not recurred to date, 6 months after the last treatment. CONCLUSION: It is felt that there may be a future for this treatment, either as primary treatment or as an adjunct to surgery in refractive cases. It could also be useful in preventing the growth of hairs into wounds that have been left open and allowed to granulate.

Laser depilation and hygiene: preventing recurrent pilonidal sinus disease.

J Plast Reconstr Aesthet Surg. 2008 Sep;61(9):1069-72. Epub 2007 Jul 30.

PMID: 17664085 [PubMed - indexed for MEDLINE]

Conroy FJ, Kandamany N, Mahaffey PJ.

University College Hospital, Galway, Ireland.

BACKGROUND: Pilonidal sinus disease of the natal cleft is a painful and debilitating condition which often recurs despite multiple surgical undertakings. We describe the long pulsed alexandrite laser for hair depilation and the role of personal hygiene, which is often overlooked when treating this disease, as an adjunct to preventing recurrent pilonidal sinus disease. METHODS: A review of 14 patients who underwent laser hair depilation in the natal cleft following pilonidal sinus surgery. The majority of patients had recurrent disease and had undergone numerous surgical procedures (range 1-5, mean 2.07) All patients were given advice regarding meticulous personal hygiene at the time of consultation. RESULTS: 12 patients received the full course of treatment (three treatments, 6-weekly) followed by 'top-up' treatments as required (mean number of treatments 3.9). None of the patients developed recurrent disease at 1-year follow up and, to date, none have required further surgery. CONCLUSION: Laser hair depilation is a useful adjunct in preventing the recurrence of pilonidal sinus disease and should be offered routinely to all patients. This coupled with patient education regarding personal hygiene reduces the risk of developing recurrent pilonidal sinus disease.