Despite the multitude of surgical techniques for the treatment of the pilonidal disease, there is no procedure with which a recurrence of cysts and fistulas can be safely ruled out despite problem-free surgery and healing. If the fistula reappears, this is called a "recurrence", which should not be confused with a protracted, prolonged wound healing disorder after fistula surgery. A "real" recurrence occurs when new pits and complaints occur after the surgical wound has completely healed. According to long-term observations, fistula recurrence occurs in more than 20% of cases after initially successful surgery, almost 30% of which occurs more than 4 years after the first surgery.
Hair removal performed regularly (once a week) immediately before fistula surgery and during the healing phase has a positive effect on wound healing, especially after radical excision and open wound treatment.
However, so-called blade shaving (e.g. with a disposable razor) during wound healing and for subsequent prevention of recurrence is controversial. Hair removal takes place in an area of the body that is difficult to access and hair breaks and cuts are produced during shaving. During open wound healing, these can fall into the wound and lead to a foreign object irritation, which either hinders wound healing or leads to a later recurrence after healing. Also, with regular shaving after healing, it is hardly possible to safely remove all broken and cut hair from the bottom fold, which can also lead to recurrences.
Permanent depilation for recurrence prevention appears to be easier with depilatory creams or lasers. The disadvantage of the creams with the regular application is the change of the skin pH-value so that the healthy barrier function of the skin is disturbed. Regular use can also cause allergies. Laser depilation can be performed before, during or after fistula surgery.
Whether the risk of a fistula recurrence can actually be significantly reduced by hair removal is unclear according to current studies, but it appears to be advantageous.
Literature sources:
Doll D, Petersen S (2008) Recurrence and wound healing disorders-two pairs of shoes. Am J Surg 195:556
Doll D (2013) 5- and 10-year recurrence rate is the new gold standard in pilonidal sinus surgery benchmarking. Med Princ Pract 19:216–217
Doll D, Friederichs J et al (2008) Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis 23:359–364
Armstrong JH, Barcia PJ (1994) Pilonidal sinus disease. The conservative approach. Arch Surg 129:914–917 (discussion 917–919)
Kandamany N, Mahaffey PJ (2008) The importance of hair control and personal hygiene in preventingrecurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61:986–987
Swinton NW, Wise RE (1955) The significance of epilation as an adjunct in the treatment of pilonidal sinus disease. Am J Surg 90:775–779
Petersen S, Wietelmann K et al (2009) Longtermeffects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 52:131–134
Lindemayr H (1984) Eczema in hairdressers. Derm Beruf Umwelt 32:5–13
