What is Pilonidal disease?

Pilonidal disease is a chronic infection of the skin in the region of the buttock crease. The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks. Pilonidal disease is more common in men and frequently occurs between puberty and age 40. It’s also common in obese people and people with thick, stiff body hair.

What are the symptoms of Pilonidal disease?

Symptoms vary from a small dimple to a large painful mass. Often, the area will drain fluid that can either be clear, cloudy or bloody. With infection, the area becomes red and tender and the drainage (pus) will have a foul odor. The infection may also cause fever, malaise or nausea.

Pilonidal disease has several common patterns. Nearly all patients have an episode of an acute abscess – the area gets swollen and tender and may drain pus. After the abscess resolves – either by itself or with medical assistance – many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface with one or more small openings, or tracts. Although a few of these sinus tracts may resolve without therapy, most patients need a small operation to eliminate all of them.

A small number of patients develop recurrent infections and inflammation of these sinus tracts accompanied by swelling, pain and drainage. Surgery is almost always required to resolve this condition.

How is pilonidal disease treated?

The treatment depends on the disease pattern. An acute abscess is managed with an incision and drained to release the pus and reduce the inflammation. This procedure usually can be performed in the office with local anesthesia. A chronic sinus usually will need to be excised or surgically opened.

Complex or recurrent disease must be treated surgically. Procedures vary from unroofing the sinuses to laser excision and possible closure with flaps.

If the wound is left open, it will require dressing or packing to keep it clean. Although it may take several weeks to heal, the success rate with open wounds is higher.

If the wound can be closed, it will need to be kept clean and dry until the skin is completely healed. Closure with flaps is a bigger operation that has a high chance of infection; however, it may be required in some patients.

After healing, the skin in the buttocks crease must be kept clean and free of hair. This is accomplished by shaving or using a hair removal agent every two or three weeks until age 30. After that, the hair shaft thins, becomes softer and the buttock cleft becomes less deep.