Pilonidal disease is an acute or chronic infection of the skin in the region of the buttock crease. The condition is believed to result from a reaction to hairs embedded in the skin, commonly occurring in the divide between the buttocks. 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. Pilonidal disease is a chronic skin infection in the buttock crease area. Two small openings are shown (A).
The origin of pilonidal disease is somewhat controversial. Some believe it is a congenital problem, implying that individuals are born with a defect of the skin in the buttock crease region that ultimately gives rise to the disease. Many believe that this disease is an acquired problem. This theory notes that a similar issue occurs within the web of the base of barbers' fingers due to the constant frictional motion of their fingers while cutting hair. This implies that shed hairs may start the condition. In reality, there is nothing anyone can do to prevent this disease.
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.
Some physicians have advocated 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. An acute abscess is managed with 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 or packing to keep it clean. Although it may take several weeks to heal, the success rate with open wounds is higher. During the healing process, the skin in the buttocks crease must be kept clean and free of hair.
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 wound.