WHAT TO DO TO MINIMIZE FLARE UPS OR RECURRENCE?
There are some strategies that can be used to try to decrease the number of painful infections and try to minimize the frequency of flare ups, keeping in mind that none of these will solve the actual problem.
These measures are encouraged even after surgery to decrease the chances of a recurrence.
Cleanliness:
Keep the area as clean as possible by showering or bathing daily with a mild antibacterial soap. Thoroughly dry the area in the cleft afterwards wiping gently with a wash cloth to trap any hairs in the cleft. This is key to avoid trapping of hair in the area.
Avoid prolonged pressure:
Prolonged pressure by sitting directly on the area for a long time, or bouncing in a vehicle can drive hair, bacteria and debris deeper into the tissues through the open pits. This usually results in a flare up (deep infection) or abscess formation. It is not uncommon for patients to have this after a prolonged car ride. If you are going to sit for a long period of time, place some padding in the form of a folded sweater or a pillow. Get up and move around every hour.
Hair removal:
Minimizing the amount of hair available to get caught in the pores can be helpful. Any method that is not irritating to the skin is acceptable, including depilatory agents, clipping, or laser hair removal. Avoid shaving as it creates small wounds that can start a pit and an infection.
However, this is not a perfect or permanent solution, since hairs from anywhere on the body can find their way into the crease, not just the hairs growing locally. In fact, recent studies have shown that most of the hairs in pilonidal disease come from the back of the head. So unless you get a complete body and head laser hair removal you cannot avoid the hair getting into the cleft with certainty.
We see a lot of patients who had several expensive sessions of laser hair removal as a treatment and obviously they continue to have the flare ups. The laser will remove the hair on the surface of the skin and does nothing to the hair tracts and debris underneath.
However, certain studies showed that hair removal for 3 inches on either side of the cleft can reduce the chances of recurrence after surgery.
Dr. Wadie does not routinely recommend hair removal after the cleft lift. However, in certain situations where the patient had several redo surgeries and is very hirsute, hair removal might add an extra layer of protection to minimize recurrence.
Antisepsis:
Some homeopathic antiseptics available are tea tree oil, garlic, turmeric, coconut oil, Epsom salts, oregano oil, vinegar, baking soda, Manuka honey, OXY pads, and aloe vera. These have some anti-inflammatory and soothing properties and have been used for reducing the chances of infection and alleviating irritation for decades. However, it is to be stressed that none of these will help treat the actual disease or get rid of the tunneling and tracts.
Some of these remedies are useful to enhance wound healing after surgery. This applies particularly to Manuka Honey.