Pilonidal Disease

What is pilonidal disease?

Pilonidal disease is a chronic infection of the skin in the area of the buttock crease. The infection develops in a cyst (pilonidal cyst) at the top of or next to the crease of the buttocks. A pilonidal cyst is a closed sac under the skin. The cyst may look like a small dimple, called a “pit” or “sinus”. Hair may protrude from the pit, and several pits may be seen. Pilonidal cysts usually do not cause problems unless they become infected.

What causes pilonidal disease?

The cause of a pilonidal disease is not clear. It may be caused by a hair follicle in the skin that becomes blocked and then infected. The disease is more common in men than women and often occurs between puberty and age 40.

What are the symptoms?

The symptoms of pilonidal disease include:

  • Pain at the top of or next to the crease of the buttocks, ranging from mild discomfort to difficulty with sitting or walking
  • Redness or swelling
  • Drainage of fluid from the pits that may be clear, cloudy, bloody, or foul-smelling
  • Fever (Temperature over 101.3 F or 38.5 C)

What is the treatment for pilonidal disease?

Based on the symptoms and the disease pattern, pilonidal disease can be divided into 3 categories, which determine the most appropriate treatment.

  • Acute Pilonidal Abscess – Almost all patients with pilonidal disease will have an episode of an acute pilonidal abscess. This is managed with incision and drainage of the pus. This can usually be performed in the office using local anesthesia. Large abscesses may require drainage in the operating room under general anesthesia. Afterwards, the wound is cleaned daily until it heals. It is important to realize, however, that drainage of the abscess usually does not cure pilonidal disease.

  • Chronic Pilonidal Sinus – After resolution of the initial abscess, most patients will develop a pilonidal sinus. The sinus is a space below the skin that connects to the skin surface with one or more small openings. In most patients an operation will be required to remove the sinus. It is usually a short procedure done in the outpatient setting. In most cases after the tracts are removed, the wound is left open to allow it to heal from the inside out. If the wound is left open it may take several weeks to heal but is only uncomfortable for a week or less.

  • Recurrent or Complex Pilonidal Disease – A small number of patients may develop recurrent pilonidal disease after appropriate excision. Others may have complex sinus disease due to extensive chronic infection. In these circumstances a larger operation is sometimes required to eliminate the disease and promote healing.
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