Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study.

OBJECTIVE: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. METHOD: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. RESULTS: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. CONCLUSION: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. DECLARATION OF INTEREST: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.

Efficacy of Laser Treatment in Pilonidal Disease: A Single-Arm Meta-Analysis.

Objective: This study aimed to collate all published studies on laser therapy for pilonidal disease and demonstrate the safety and effectiveness of minimally invasive techniques. Methods: A comprehensive literature search, with no language limitations, was performed using PubMed, Embase, and Web of Science from inception to April 23, 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and evaluated the bias risk of included studies. Meta-analysis was performed using RevMan software (version 5.4). (PROSPERO Registration ID Number CRD42023420803). Results: The analysis included 1214 patients from 13 studies, who fulfilled the pre-defined inclusion criteria. With a median follow-up of 12 (range, 7.8-25) months, 1000 (84.4%) patients achieved healing after primary laser treatment. The mean complication and recurrence rates were 12.7% and 7.6%, respectively. Conclusions: Laser ablation for pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low postoperative recovery, and shorter recovery periods following employment.

Comorbidities are not associated with pain symptom or recurrence in patients with pilonidal disease.

BACKGROUND: Comorbidities can potentially impact the presentation or outcome of patients with pilonidal disease (PD) due to poor wound healing or increased inflammatory response. We hypothesized that certain comorbidities could lead to worse pain or higher recurrence rate. METHODS: A retrospective study was performed on all PD patients treated with standardized minimally invasive protocol at our clinic 2019-2022. Patients' demographics, comorbidities, initial/follow-up pain score, pain duration, and recurrence were recorded. Data were analyzed by t test and Chi-square test. RESULTS: Of 207 total PD patients (108 male, 99 female), 61 had comorbidities. Mean age was 18.2 years. The recurrence rate was 7%, and patients with recurrence were significantly younger. Associated comorbidities included mood/psychiatric disorders (31%), asthma/respiratory illness (30%), obesity-related illness (15%), gastrointestinal disorders (13%), diabetes (10%), thyroid disease (8%), cardiac disease (8%), musculoskeletal/connective tissue disorders (7%), immunologic disease (7%), inflammatory bowel disease (5%), and chest wall disorders (3%). The presence of comorbidities was not associated with PD recurrence. By dividing patients into adolescents (< 18 years) and adults (≥ 18 years), we found no association between comorbidity and recurrence in either group. 55% of patients had pain as an initial symptom. The initial pain score, pain duration, and pain score at follow-up were not associated with comorbidities. The comorbidities and recurrence were not associated with patient age or sex. CONCLUSIONS: Having comorbidities was not associated with pain symptoms or recurrence in PD patients. Even though patients with recurrence were younger, there was no association between comorbidity and recurrence in either adolescents or adults.

Pilonidal disease in the pregnant patient: A case report.

INTRODUCTION: Pilonidal disease in the pregnant patient is underreported and may be instigated by significant shifts in hormone levels throughout pregnancy and the postpartum period. PRESENTATION OF CASE: An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy. While pregnant, her symptoms recurred once and resolved without treatment. She was managed non-operatively during pregnancy. Her symptoms recurred again in the postpartum period but they quickly resolved. Due to the recurrent symptoms, she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence. DISCUSSION: Pilonidal disease affects pregnant patients and can be managed non-operatively. The etiology of pilonidal disease in the setting of pregnancy may be related to hormonal shifts and warrants further investigation. CONCLUSION: We present the first report of pilonidal disease in a pregnant patient in the primary literature. The hormonal shifts associated with pregnancy may be associated with the development of pilonidal disease in the pregnant patient.

Pilonidal sinus: an overview of historical and current management modalities.

Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment.

PURPOSE: Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches-excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT). METHODS: Single-center retrospective evaluation of patients 1-21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann-Whitney U tests. RESULTS: 18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031). CONCLUSION: In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.

New factors affecting wound healing and recurrence after pilonidal sinus surgery in adolescents; seborrheic dermatitis and psychiatric co-occurring conditions.

Postoperative wound healing problems and recurrence remain common for pilonidal sinus disease (PSD). Our study aimed to examine the effect of comorbidities in addition to the classic known factors that may affect wound complications and recurrence after PSD surgery. We retrospectively analysed 282 adolescent patients operated on in our clinic between 2014 and 2021. We gathered the postoperative wound healing patterns of the patients under four groups. With a mean age of 15.49 ± 1.45, 59.9% (n = 169) were male, 40.1% (n = 113) were female and 23.8% (n = 67) had recurrence. When examined according to the wound healing groups, 53.5% (n = 151) had an uneventful wound, 22.6% (n = 64) had prolonged wound care, 17.7% (n = 50) of the postoperative wounds did not close and had a recurrence and 6% (n = 17) had recurrence after the wound was healed. The number of sinuses, abscess presentation and the incidence of comorbid disease in group 1 were found to be statistically significantly lower than all other groups. Seborrheic dermatitis, obesity and psychiatric diagnoses showed high statistical association with group 3 and acne with group 4. In patients with seborrheic dermatitis or psychiatric diagnosis, a significant correlation was found between wound healing according to the type of surgery (p < 0.05). The wound healing patterns of these patients after total excision and primary closure surgeries were included in Group 3 with a statistically significant high rate. As two new factors, the significance of the presence of seborrheic dermatitis and psychiatric comorbidities should be evaluated in these patients whose wounds remain open postoperatively and do not respond to primary wound care and eventually relapse. Further histologic and pathologic investigations are needed for seborrheic dermatitis and PSD relation. Awareness of these diseases may change the decision of the type of surgery, and their treatment within the same time may support wound healing and ultimately reduce recurrence.

Using "Appointment Tickets" to Track Visit Duration as a Quality Improvement Initiative After Incorporating Laser Epilation in a Pilonidal Care Clinic.

BACKGROUND: Laser epilation (LE) is effective in decreasing pilonidal disease (PD) recurrence, but laser use has not been a standard practice in pediatric surgery clinic. We hypothesized that "appointment tickets" can 1) track utilization and clinic visit delays, 2) inform patients of their clinic progress in real time. METHODS: An observation study was performed on LE patients treated at our PD clinic 3/2021-7/2022. Two exam rooms were utilized for manual shaving and one for LE. After gluteal cleft hair shaving, various anesthetic (topical lidocaine, ice, or cryotherapy) was applied prior/during LE. At each visit, patient received an "appointment ticket" on which providers recorded the visit start/end time, manual shaving duration, local anesthetic application/wait time, LE duration. Visits were scheduled for 20 min-slots. Clinic staff recorded any delays (>20 min). RESULTS: 1317 visits were recorded. Mean number of visits per week was 18 ± 6. Mean total visit length was 60 ± 22 min, mean shaving time 15 ± 11 min, mean anesthetic application/wait time 16 ± 11 min, mean LE time 14 ± 9 min. Over the study period, average visit length has decreased, and average visits/clinic day has increased. Most delays occurred in months April, May, October-December. Delays due to patient late arrival occurred in May, July, and August of 2021, none in 2022. CONCLUSIONS: LE visits have multiple components that required close coordination to ensure no clinic delays. Clinic delays spiked prior to summer and winter holidays. "Appointment tickets" provided patients with real-time visit progress tracked clinic utilization to improve the quality of pilonidal care delivery. LEVEL OF EVIDENCE: Level IV.

Platelet-rich plasma for pilonidal disease: a systematic review.

OBJECTIVE: To examine the use of platelet-rich plasma (PRP) for treatment of pilonidal disease (PD) and thus provide a reference for clinical application. METHODS: A systematic review of PubMed and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We considered all studies that reported the use of PRP for treatment of PD. Extracted data included the first author's name, year of publication, study type, number of included patients, inclusion and exclusion criteria, interventions, anesthesia, application of PRP (source, preparation, dose, and operation), antibiotics, follow-up time, therapeutic outcomes, and adverse events. RESULTS: In total, eight randomized controlled trials and one prospective cohort study involving 809 patients were included. PRP reduced pain, accelerated healing, and reduced adverse events. The application of combined minimally invasive surgery achieved better results. However, overfilling of the wound with PRP in minimally invasive surgeries was shown to potentially increase the risk of adverse events. CONCLUSION: PRP can be used as an adjuvant treatment in PD surgery to improve the therapeutic effect and reduce adverse events. The optimal combination of PRP and various factors is an important direction of future research.INPLASY registration number: INPLASY2023100070.

An international survey exploring the management of pilonidal disease.

AIM: Pilonidal disease (PD) is a common debilitating condition frequently seen in surgical practice. Several available treatments carry different benefit/risk balances. The aim of this study was to snapshot the current management of PD across European countries. METHOD: Members affiliated to the European Society of Coloproctology were invited to join the survey. An invitation was extended to others via social media. The predictive power of respondents' and hospitals' demographics on the change of therapeutic approach was explored. RESULTS: Respondents (n = 452) were mostly men (77%), aged 26-60 years, practising in both academic and public hospitals and with fair distribution between colorectal (51%) and general (48%) surgeons. A total of 331 (73%) respondents recommended surgery at first presentation of the disease. Up to 80% of them recommended antibiotic therapy and 95% did not use any classification of PD. A primary closure technique was the preferred procedure (29%), followed by open technique (22%), flap creation (7%), sinusectomy (7%) and marsupialization (7%). Approximately 27% of subjects would choose the same surgical technique even after a failure. Almost half (46%) perform surgery as office based. A conservative approach was negatively associated with acutely presenting PD (p < 0.001). Respondents who were not considering tailored surgery based on patient presentation tended to change their approach in the case of a failed procedure. CONCLUSION: With the caveat of a heterogeneous number of respondents across countries, the results of our snapshot survey may inform the development of future guidelines.

Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.

INTRODUCTION: Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients with regular epilation alone had similar recurrence rate as patients who were also treated surgically. METHOD: Patient data were prospectively collected 2/2019-11/2022 at our Pilonidal Clinic. All patients received regular epilation; all patients presented before 12/2020 also underwent pit excision using trephines. Starting 1/2021, only symptomatic patients underwent pit excision; symptom-free patients at presentation received only regular epilation. Recurrence rates were statistically analyzed. RESULTS: 255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days (IQR:367.5-847). 44.1% identified as Hispanic, 36.5% Caucasian, 17.1% Asian, 2.4% Black. Median symptom duration at presentation was 180.5days (IQR:44.5-542.5). 160 patients were initially treated with surgical excision and regular epilation, while 95 patients with regular epilation only. The failure rate between patients who received surgical excision initially and recurred (9.4%) and patients who received epilation only and recurred (12.6%) was similar, after controlling for sex, race, age, comorbidities, skin type, hair color, hair thickness (p > 0.05). Patients who recurred after only undergoing regular epilation all underwent surgical excision, median 100days (IQR:59.5-123.5) after initial presentation. CONCLUSION: Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.

Pilonidal Disease: To Flap or Not to Flap.

Pilonidal disease is an acquired disease caused by infected hair follicles imbedded in the midline gluteal area. The diagnosis is made based on clinic examination. Treatment is based on disease severity with minimal invasive techniques like the Bascom I procedure, Moshe Gibs procedure, or video-assisted pilonidal sinus ablation best suited for less complicated cases. However, for recalcitrant diseases, more advanced techniques are needed such as the Karydakis, Limberg, or V-Y advancement flaps.

Cleft closure (the Bascom cleft lift) for 714 patients-treatment of choice for complex and recurrent pilonidal disease (a cohort study).

AIM: Pilonidal disease is a benign condition that affects mainly the young. In existing literature, there is no consensus for best treatment, with multiple operative techniques described, some complex, resulting in a high proportion of failure and/or morbidity. The cleft closure (or cleft lift) described by Bascom and Bascom (Arch Surg, 137, 2002, 1146-50), by comparison, is a simple operation, resulting in healing in the majority and good cosmesis. METHOD: This is a single surgeon series, with the aim of evaluating outcomes for consecutive patients who underwent cleft closure surgery at two centres (St Mark's Hospital, London, and Queen Alexandra Hospital, Portsmouth) between 1995 and 2021 for either extensive, complex or recurrent pilonidal disease. Primary study outcomes that were measured included rate of primary healing, time to complete healing and rate of recurrence. RESULTS: Some 714 patients had a cleft closure of whom 656 had documented follow-up. Primary healing occurred in 60.7% (n = 398) rising to 88.5% by 12 weeks (n = 562) and 91.8% by 16 weeks. The remaining patients healed over the following weeks with only 19 wounds failing to heal completely (3%), requiring further surgery to achieve healing. After complete healing 5.3% of patients developed recurrent disease at a median of 12 months. CONCLUSION: Cleft closure is an effective operation for pilonidal disease. Overall, 97% of patients healed without further surgery. A 3% failure rate and 5.3% recurrence rate were observed. This technique could be considered as an alternative procedure to complex flaps or midline excision, in extensive, recurrent and unhealed pilonidal disease.

Endoscopic Pilonidal Sinus Treatment: Preliminary Results, Learning Curve and Comparison with Standard Open Approach.

Background: Pilonidal sinus (PNS) is a common disease which can lead to complications including infection and abscess formation. Different surgical approaches have been suggested, based on primary or secondary wound closure intention healing or endoscopic treatment (EPSiT). The aim of this study is to verify the superior outcomes of EPSiT, especially in comparison with the traditional open approach, and discuss the operators' learning curve. Methods: A retrospective study was conducted identifying all the patients who underwent surgical treatment for PNS with EPSiT technique between 2019 and 2022 and with open technique between 2002 and 2022. We divided patients in two groups: open procedure (group 1) and EPSiT (group 2). We considered a p value < 0.05 as statistically significant. Results: The mean operative time was 58.6 ± 23.7 min for group 1 and 42.8 ± 17.4 min for group 2 (p < 0.01). The mean hospital stay was 2.6 ± 1.7 days for group 1 patients and of 0.8 ± 0.4 days for group 2 (p < 0.01). Complete healing was obtained in 18.7 ± 5.6 days for group 1 and 38.3 ± 23.5 days for group 2 (p < 0.01). Recurrences were of 23.4% for group 1 and 5.4% for group 2 (p = 0.03). Conclusions: EPSiT is a minimally invasive and effective approach for the treatment of pilonidal cyst that can be safely performed in pediatric patients with promising results concerning aesthetic outcome and pain control, and with a rapid and less complicated recovery compared to traditional open procedures.

Long-term results for pit-picking and flap procedures in primary pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery. METHODS: We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups. RESULTS: PSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4-10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001). CONCLUSIONS: PPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.

An effective and considerable treatment of pilonidal sinus disease by laser ablation.

The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470-nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470-nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14-42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470-nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.

Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease.

Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.

Revision of the Failed Cleft Lift for Pilonidal Disease.

The cleft lift has been demonstrated to be one of the most successful operations for the treatment of pilonidal disease, however, there are times this procedure fails and further surgery is necessary. This article describes a reproducible and successful technique for the revision of a failed cleft lift. This procedure was performed on 76 consecutive patients who had previous cleft lift procedures. Failures were manifested by either a wound, sinus, abscess, dehiscence or fragile scar. The revision flattened the lower gluteal cleft with a rotation and advancement flap that placed the skin incision off-midline. Follow-up over the 10 years of this series was between six and 124 months with an average of 36 months. The revision was initially successful in 96.1% of patients; if the procedure was unsuccessful a repeat revision was subsequently curative. This procedure is proposed as an essential part of the treatment algorithm for patients with recurrent pilonidal disease after a cleft lift operation.

Increasing Amount of Hair Reduction using Laser Correlates with Lower Probability of Recurrence in Patients with Pilonidal Disease.

BACKGROUND: Hair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. METHODS: PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. RESULTS: 198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8-6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. CONCLUSION: Patients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. LEVEL OF EVIDENCE: Level IV.