Pilonidal Disease

What is pilonidal disease and what causes it?

Pilonidal disease is an acute or chronic infection of the skin in the region of the buttock crease. The condition is a result hairs embedded in the skin. The disease is more common in men than women and frequently occurs between puberty and age 40. It occurs more frequently in obese people and those with thick, stiff body hair. It is estimated to occur in up to 0.7% of adolescent and young adult males and less so in females.

What are the symptoms?

Symptoms vary from a small dimple to a large, painful mass. Often the area will drain fluid that may be clear, cloudy, or bloody. With infection, the area becomes red and tender, and the drainage (pus) will have a foul odor. A small number of patients develop recurrent infections and inflammation of these sinus tracts. The chronic disease causes episodes of swelling, pain, and drainage. Surgery is almost always required to resolve the chronic part of this condition.

How is pilonidal disease treated?

First Step in treatment of the disease includes hair removal and shaving to treat the simple form of the disease because pilonidal disease has been clearly linked to excessive hair in the gluteal cleft. The treatment, however, depends on the disease pattern. Hygiene is also very important

An acute infection may be managed with antibiotics if it is caught early. But it is important to notify your surgeon if you have a suspicion that this is happening. Common symptoms include pain and redness. 

Large infection may require an incision to drain the pus and to reduce the inflammation and pain. This procedure usually can be performed in the office with local anesthesia. A chronic sinus usually will need to be removed or surgically opened. 

Complex or recurrent disease is often treated surgically. Procedures vary from unroofing the sinuses to complete removal and possible closure with flaps. If the wound is left open, it will require dressing

What happens after the surgery?

Most patients have a normal recovery, although the wounds usually take several weeks to heal. During this time, you may need to perform daily dressing changes on open wounds. The surgeon will routinely see you until the wounds are completely healed.

Your surgeon may leave a drain in the surgical field to facilitate drainage of the cavity. Drainage is a good thing because it prevents the fluid from remaining in the cavity allowing it to close from the inside out.  Sutures are usually removed after several weeks in clinic.