Pilonidal disease is a common debilitating condition that usually affects young men of working age.
An acquired disease in which hair follicles become inserted into the skin, creating a chronic sinus tract, usually in the natal cleft.
Conservative (non-surgical) treatments have yielded mixed reports of success. Definitive treatment is usually surgical, although many different techniques are available, and complications of tissue healing are frequent.
Acute infection may lead to a pilonidal abscess, requiring urgent surgical drainage.
Pilonidal sinus is caused by the forceful insertion of hairs into the skin of the natal cleft in the sacrococcygeal area. This promotes a chronic inflammatory reaction, causing an epithelialised sinus. Sinuses may be multiple and communicate via a deep cavity. Chronic discharge usually occurs. Infection may supervene and lead to an abscess.
History and exam
Key diagnostic factors
- sacrococcygeal discharge
- sacrococcygeal pain and swelling
- sacrococcygeal sinus tracts
Other diagnostic factors
- presence of risk factors
- history of prior rupture of fluid into natal cleft
- skin maceration
- acutely increased natal cleft pain and swelling
- fever or toxaemia
- male sex
- age 16 to 40 years
- family history of pilonidal disease
- stiff hair and hirsutism
1st investigations to order
- clinical diagnosis
symptomatic: primary disease
symptomatic: recurrent disease
- Perianal fistula
- Perianal abscess
- Hidradenitis suppurativa
- Practice parameters for the management of pilonidal disease
- German national guideline on the management of pilonidal disease
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