Pilonidal Disease

The term pilonidal means, “nest of hair.” A pilonidal sinus is any tract or cavity under the skin that contains loose hair. Pilonidal cysts occur more often in overweight people, persons with abundant body hair, and, in adults, (although in children, girls are more commonly affected). The average age at presentation is 12 years in males and 19 in females. In the U.S., pilonidal disease affects approximately 26 per 100,000 people.

Some doctors believe that trauma to the area causes pilonidal cysts, while others believe they are caused by ingrown hairs. Symptoms include pain, swelling, and drainage. Some babies are born with a pilonidal dimple, (a small depression or 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 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 un-roofing the sinus, to excision with the wound left open or closed with flaps, to marsupiliazation (creation of a pouch). These procedures are usually done by colon and rectal surgeons. Your surgeon will discuss the options with you and help you select the appropriate.

References
www.nlm.nih.gov/medlineplus
www.emedicine.com

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