Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial

Introduction: Pilonidal disease is a common condition affecting adolescents and young adults with high recurrence rates and disease-associated morbidity. Identification of patient-specific factors and treatments associated with decreased disease recurrence can assist providers with treatment selection and patient counseling. Materials and methods: This is a planned secondary analysis of a single institution, randomized controlled trial which compared laser depilation as an adjunct to standard care versus standard care alone. Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease. Patients were randomized to receive laser depilation in conjunction with standard treatment versus standard treatment alone. Multivariable logistic regression modeling was performed to identify variables independently associated with disease recurrence including laser depilation, patient variables (biologic sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, health insurance status), and annual family income. Results: Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial. After adjusting for sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, type of health insurance, and household income, laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001). After adjusting for other covariables, there was a significant interaction between laser hair treatment and health insurance type. Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58). Conclusions: Laser depilation is associated with decreased pilonidal disease recurrence. However, there may be heterogeneity of treatment effect based on insurance status with laser depilation decreasing recurrence in patients with private insurance and being less effective in patients with public insurance. This heterogeneity of treatment effect may be related to barriers to care and social determinants of health and warrants further investigation.