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 (nonsurgical) 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 epithelialized 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
- at risk demographic (male, age 16 to 40 years)
- history of prior rupture of fluid into natal cleft
- skin maceration
- acutely increased natal cleft pain and swelling
- fever or toxemia
- male gender
- 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
- SSAT patient care guidelines: treatment of perineal suppurative processes
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer