Dr Devesh Kaushal

Pilonidal Disease

Pilonidal disease is a chronic skin infection that occurs in the crease of the buttocks near the coccyx (tailbone). It often begins as a cyst, which is a small sac that can contain hair, skin debris, and other tissue. Pilonidal cysts may become infected and cause an abscess or spread into sinus tracts.

What Causes Pilonidal Disease?

  • Hair Penetration: Loose hairs can penetrate the skin in the cleft of the buttocks, which may be due to friction and pressure from sitting for long periods, tight clothing, or thick, coarse body hair.
  • Friction and Pressure: Activities that cause prolonged sitting or friction, such as driving or riding a bike, can exacerbate the condition.
  • Hormonal Changes: Hormonal changes during puberty can increase hair growth and skin oiliness, contributing to the risk.
  • Obesity: Higher body mass index (BMI) can increase the risk of developing pilonidal disease.
  • Inflammation: Local irritation and inflammation can make the skin more vulnerable to infection.

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

Pilonidal disease can be a chronic condition with a tendency to recur. Even after surgical treatment, it is important to maintain skin hygiene and make the necessary lifestyle changes in order to reduce the risk of recurrence. However, with appropriate treatment and care, most people recover fully and are able to return to their normal activities.

Dr Devesh Kaushal is a Specialist General Surgeon and a Fellow of the Royal Australian College of Surgeons (FRACS).

Dr Kaushal offers 15+ years of experience and holds a Master of Surgery Degree, as well as being fully certified in gastroscopy and colonoscopy by the Gastroenterology Society of Australia (GESA).

Dr Kaushal takes an empathetic, warm-hearted and friendly approach to patient care and is completely dedicated to patient outcomes.

He consults and operates across Souther-Western Sydney.