Pilonidal Disease

• Pilonidal* disease (term pilonidal means, "nest of hair.") is an infection in the skin just above the crease of the buttocks. The condition occurs more often in overweight people, persons with abundant body hair, and, in adults, males (although, in children, girls are more commonly affected). The disease is also more likely in people who sit for long periods or wear tight clothing. The average age at presentation is 21 years in males and 19 in females. In the US, pilonidal disease affects approximately 26 per 100,000 people.


• A pilonidal sinus is any tract or cavity beneath the skin over the tailbone (coccyx) that contains loose hair. It often looks like a dimple or pit in the skin.


• A pilonidal cyst is a closed sac under the skin. They usually do not cause problems.


• A pilonidal abscess develops when the cyst becomes infected, swells, and ruptures into the surrounding tissue. Symptoms include pain, swelling, and drainage of pus.

Some doctors believe that trauma to the area causes pilonidal cysts while others believe they are caused by ingrown hairs. Some babies are born with a pilonidal dimple (a small depression or pit at the very top of the crease between the buttocks). In the past, doctors thought that these developed into pilonidal cysts at adolescence, but this theory has been called into question.

Nearly all patients have an episode of acute abscess. An acute abscess is treated with incision and drainage (making a small opening in the skin over the abscess) to release the pus, and decrease inflammation and pain. Often, antibiotics are prescribed. This is a minor procedure which can usually be done in the office with local anesthesia.

A few patients develop chronic or recurrent inflammation or infection. A chronic abscess usually requires surgical treatment, ranging from unroofing the sinus, to excision with the wound left open or closed with flaps, to marsupialization (creation of a pouch). These procedures are done by surgeons, usually colon and rectal surgeons. Your surgeon will discuss the options with you and help you select the appropriate treatment.

References