The Use of Laser Hair Removal as a Non-Surgical Treatment Approach in Pilonidal Disease: A Systematic Review

Background: Although a vast number of different surgical procedures can be used in the treatment of Pilonidal sinus disease (PSD), the rate of recurrence is also unacceptable, as it ranges from 11% to 50%, depending upon the treatment method. Laser hair removal (LHR) is an interesting, minimally invasive, non-surgical approach targeting this pathophysiological mechanism directly. This systematic review examines the literature that supports the use of LHR as a non-surgical intervention mode, as a primary treatment procedure, and as a surgical adjunct in treatment of PSD. Methods: The PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Google Scholar were searched during the month of January 2026. Studies that reported the use of LHR (Alexandrite, Nd:YAG, Diode, Ruby, or IPL) in patients with PSD and reported at least one clinical outcome were eligible. Two reviewers independently selected the studies, extracted data and assessed the quality of the studies. Quality appraisal of non-randomised and randomised studies was done using Newcastle-Ottawa Scale (NOS) and Cochrane Risk of Bias tool, respectively. Results: Eleven studies were included and consisted of five randomised controlled trials (RCTs), three prospective cohort studies, two retrospective studies, and one case-control study. LHR as a post-operative adjunct showed a consistent decrease in PSD recurrence rates when compared to no hair removal or standard hair removal: post-operation recurrence in LHR ranged between 0% and 13.3% with control groups ranging between 17.1% and 61.7%. There was a total of 870 participants and in these studies, the modalities that were most commonly used for treatment were the Alexandrite (755 nm) laser, Diode and Nd:YAG (1064 nm) laser. All studies consistently reported LHR being safe, well-tolerated, and with nil to a low rate of adverse events. Conclusion: LHR is a safe, effective and evidence-based approach to lowering PSD recurrence in the case of post-operative adjunct. Preliminary evidence, currently limited to small pilot and subgroup data, raises the possibility of a role for LHR as a first-line non-surgical intervention, particularly for patients who wish to avoid or postpone surgery; this indication is not yet established and requires confirmation in larger, adequately powered studies. The effectiveness of treatment is best predicted by the number of LHR sessions. Existing heterogeneity on the study design, laser protocols and outcome reporting inhibits conclusive comparative analysis.