Pilonidal Disease

Pilonidal disease can be asymptomatic, but when it flares up, symptoms may include:

• Painful, swollen area on the buttocks, especially when sitting or touching the area
• Reddened, warm skin over the area
• Pus or blood draining from an opening in the skin
• Unpleasant odour from the draining pus
• Hair protruding from the lesion
• Fever and malaise (with severe infection)

Diagnosis is typically made through a physical examination of the area. Your doctor may also ask about your symptoms and risk factors. Imaging studies are not usually needed unless the doctor suspects an underlying abnormality or to delineate complex pilonidal sinus tracts before surgery.

Conservative Treatment:

For small, asymptomatic cysts or for acute pilonidal abscesses:

• Antibiotics: If there is evidence of severe infection or cellulitis, antibiotics may be prescribed.
• Incision and Drainage: The primary treatment for an acute abscess is incision and drainage, which can often be done in an outpatient setting.
• Pain Relief: Over-the-counter pain relievers may help manage discomfort.

Aftercare Following Incision and Drainage:

• Wound care, including cleaning and dressing changes
• Avoiding prolonged sitting and direct pressure on the affected area
• Hair removal around the area to prevent recurrence, which can be by shaving or using hair removal creams

Surgical Treatment Options:

For recurrent or complex pilonidal disease:

• Excision: The entire cyst and sinus tract are removed, and the wound is either left open to heal from the inside-out, or closed with sutures.
• Pit Picking: A minimally invasive procedure that removes the pits where the hairs accumulate.
• Flap Procedures: Techniques such as the cleft lift procedure or rotational flap techniques can be used to fill the defect and move the incision off the midline.
• Laser Therapy: Used in some cases to destroy the sinus tracts.

Lifestyle Adjustments:

• Regular hygiene and keeping the area clean and dry
• Weight loss if overweight or obese
• Avoiding sitting for prolonged periods if possible
• Regular hair removal in the area through shaving or other methods to prevent hair from entering the sinus tracts

Recovery from pilonidal disease surgery depends on the procedure performed. Open wounds may require daily care and take several weeks to heal, while closed wounds typically heal faster but have a higher risk of recurrence. During recovery, avoiding direct pressure on the wound, maintaining good hygiene, and following the surgeon’s instructions are essential for optimal healing.

• Infection
• Recurrence of the pilonidal disease
• Prolonged healing time, particularly for open wound management
• Scarring