What is Pilonidal Disease?

What is Pilonidal Disease?

By Rodney J. Kratz, MD
Colon & Rectal Surgeon

Pilonidal disease is a subcutaneous skin infection that occurs in the upper half of the gluteal cleft (the tailbone area, and/or between the buttocks). 

Etiology

The term “Pilonidal” means nest of hairs.  Interestingly, in 50% of reported cases, there was not any hair found within the pilonidal abscess.  This is routinely the case for females.  Although hair can contribute, the most common cause of pilonidal disease is an exploded follicle called a pit, which is located in the gluteal cleft, or midline region (between the buttocks). 

Who is at risk for Pilonidal disease?

Pilonidal disease is only slightly more common in men than women, and is most likely to occur between the ages of 16 – 26, correlating with puberty.  It should be noted that pilonidal disease can develop in younger and older age groups.  Pilonidal disease occurs less in Asian and black populations.  Other risk factors of pilonidal disease include:

  • Obesity
  • Sedentary lifestyle
  • Individuals with more body hair
  • Occupations with prolonged sitting

Diagnosing Pilonidal Disease

Pilonidal disease, similar to a large pimple, can burst through the skin by itself or may need to be lanced or drained to let the infected fluid escape.  Pilonidal disease is classified into three stages:
 

  • Acute Pilonidal Abscess – Characterized by a painful, subcutaneous mass infiltrating surrounding tissues.
  • Chronic Pilonidal Sinus – Presents with intermittent pain and drainage from the wound.  Hair may be visible in the area of the infection/drainage.
  • Recurrent or Complex Pilonidal Sinus – Occasionally following treatment, recurrent pilonidal disease can occur.

Treatment

Acute treatment includes draining the infection in the office.  This is done by numbing the area with a local anesthetic, and letting the infection drain.  Once the fluid is released the pain will rapidly begin to disappear.  It usually is not necessary to treat the infection with antibiotics. 

If the area becomes infected repeatedly, and does not heal on its own, then outpatient surgery may be required to correct the condition.  Most patients are able to go home a couple hours after surgery. 

Following drainage or surgery, most people are problem-free.  In rare instances, pilonidal disease can return and can often be managed with outpatient surgery.

For questions or to schedule an appointment, please call (206)386-6600.

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