General Thoughts on Pilonidal Disease*:
Pilonidal disease occurs in the natal cleft as a result of midline openings or pits. Hair and bacteria can get inside the pits, and lead to infections, cyst and fistula tracts. This can become a chronic problem.
Historically treatment revolved removing the infected area, and either leaving the hole open or closing the incision. More recently, Dr. Bascom from Oregon developed a procedure called the "Cleft Lift" which involves removing the infected tissue and moving one area of the cleft over to the other side, creating an incision that is away from the midline. Dr. Bascom's procedure has become the "gold standard" in pilonidal surgery because the outcomes are better than the traditional approach.
More recently, several researchers described using a LASER to remove the hair in the area. This procedure allows the body to heal surgical incisions, without hair as a foreign body that can get into the wound. Lasers probably stimulate healing as well and are now being used as a first line approach before or instead of surgery.
In my practice I use both techniques. I recommend LASER to any patient that has dark hair and lighter colored skin. If LASER fails to cure people, or the patient has blonde or red hair, I perform the Cleft Lift procedure.
Generally I recommend people shave the area around the cleft with a clipper once per week if they are not undergoing LASER therapy. I highly recommend all pilonidal patient wash with Hibiclens antimicrobial soap daily during the time they have a pilonidal cyst or sinus and for a year after they have been medically "cured".
Pilonidal.org offers information on surgeons who perform the Cleft Lift procedure in every state. Information on LASER treatment is not yet readily available.
—Michael Reinhorn, M.D. FACS
*The above information is provided as educational material to people who are interested in my thoughts on Pilonidal disease and its treatment options. This information is publicly available in many forms. This information is not intended as a substitute for professional evaluation by an experienced surgeon. As a practicing surgeon, I am happy to evaluate any patient, in person, in my office to provide medical advice tailored to that patient.