Understanding Pilonidal disease, Pilonidal cyst or abscess

What is Pilonidal Disease?

Pilonidal disease is a chronic skin condition typically near the tailbone (coccyx), at the top of the buttocks crease. It’s characterized by developing a pilonidal cyst or abscess, often containing hair, skin debris, and fluid. The term "pilonidal" means "nest of hair," which gives insight into one of the main contributing factors to this condition. Pilonidal disease can cause significant discomfort and can sometimes lead to infection if left untreated. 

Who is at Risk?

While pilonidal disease can affect anyone, it is most common in young adults, especially males, typically between the ages of 15 and 35. Pilonidal disease is estimated to affect up to 0.7% of adolescent and young adult males, and it occurs less frequently in females. Risk factors include:

• Excess body hair: Hair in the area can easily become embedded in the skin.

• Sitting for prolonged periods: Those with sedentary jobs or lifestyles are more susceptible.

• Obesity: Extra weight can put pressure on the lower back and buttocks.

• Family history: Genetics can play a role, with some individuals more prone to developing pilonidal disease.

• Poor hygiene: Accumulation of sweat and bacteria can contribute to infection.

Symptoms of Pilonidal Disease

The early stages of pilonidal disease may not present any symptoms. However, as the condition worsens, common signs and symptoms may include:

• Pain or discomfort in the area, particularly when sitting.

• Redness or swelling at the top of the buttocks.

• Drainage of pus or blood from the cyst, which may have a foul smell.

• Fever in cases where the cyst becomes infected.

If the cyst becomes infected, it can develop into a painful abscess that requires prompt treatment.

Diagnosis and Treatment

A healthcare provider can usually diagnose pilonidal disease through a simple physical examination. Imaging tests are usually not needed

Treatment options vary depending on the severity of the condition:

1. Conservative Care: In early or mild cases, conservative treatments such as keeping the area clean and dry, regular hair removal, and avoiding prolonged sitting may help prevent the condition from worsening.

2. Antibiotics: Antibiotics may be prescribed for acute infections, especially if caught early. However, it’s essential to notify your doctor if you suspect an infection typically characterized by pain and redness.

3. Incision and Drainage: A doctor may need to make an incision to drain the pus for infected pilonidal cysts. This is typically an outpatient procedure with local anesthesia, providing immediate relief.

4. Surgical Excision: In recurrent or severe cases, surgery may be necessary to remove the cyst and surrounding tissue entirely. Different surgical techniques are available, including wide excision. After surgery, proper wound care is crucial to promote healing and reduce the risk of recurrence. Because of the location, high rates of postoperative infection can occur. 

5. Laser Hair Removal: Since hair growth contributes to pilonidal disease, laser hair removal around the affected area can be an effective preventative measure.

What Happens After Surgery?

Recovery from pilonidal surgery is generally straightforward, though healing can take several weeks. If the wound is left open, patients may need to perform daily dressing changes, and regular follow-ups with the surgeon are necessary to ensure proper healing.

• Drain Placement: Sometimes, a drain is placed to help remove fluid from the surgical site and prevent complications.

• Suture Removal: If sutures are used, they are typically removed in the clinic after a few weeks.

• Wound Care: Good hygiene is essential during the recovery period to avoid infection and promote healing.

Most patients experience a full recovery, although wound care can be time-consuming. Following your surgeon’s instructions for wound management and attending follow-up appointments are crucial for ensuring the area heals properly.

Preventing Recurrence

Recurrence is a concern with pilonidal disease, but certain steps can help minimize the chances of it returning:

• Keep the area clean: Daily hygiene is essential, particularly in the gluteal cleft.

• Remove hair regularly: Shaving or laser hair removal can reduce the likelihood of hair becoming embedded.

• Avoid prolonged sitting: Regular movement or standing can help alleviate pressure on the area.

• Maintain a healthy weight: A balanced diet and exercise can reduce pressure on the lower back and buttocks.

When to See a Doctor

If you notice any signs of a pilonidal cyst—such as pain, swelling, or drainage from the area—it’s essential to seek medical attention promptly. Early treatment can prevent complications, like infection or the need for more invasive procedures.

Final Thoughts

Pilonidal disease can be painful and disruptive, but with appropriate care, it’s manageable. If you’re experiencing symptoms or have concerns about pilonidal disease, consult a surgeon to discuss the best treatment options for your condition. Treatment usually requires a step-up approach, and your surgeon may use different strategies to avoid surgery if possible. Early intervention and preventive measures can make a significant difference in managing this condition effectively.

Derived from the American College of Colorectal Surgeons