Pilonidal Disease

Pilonidal disease is a chronic infection of the skin in the region of the buttock crease. The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks. The condition is not contagious and is more common in men than women, most frequently between puberty and age 40.

Symptoms

Symptoms may include:

  • Pain which often gets worse when sitting
  • A pilonidal cyst is often red and tender, ranging in size from a small dimple to a large mass
  • An abscess with draining pus or blood. This fluid may be foul-smelling.
  • Nausea, fever and extreme tiredness (fatigue).

There are several common patterns of this disease. Nearly all patients have an episode of an acute abscess (the area is swollen, tender and may drain pus). After the abscess resolves, either by itself or with medical assistance, many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface with one or more small openings or tracts. Although a few of these sinus tracts resolve without therapy, most patients need a small procedure to eliminate them.

A small number of patients develop recurrent infections and inflammation of these sinus tracts. The chronic disease causes episodes of swelling, pain, and drainage. Surgery is almost always required to resolve this condition.

Treatment

Depending on the severity of symptoms, a number of treatment methods are available. Our expert team can advise you in the best options, including:

  • Draining the cyst This procedure can happen right in your provider’s office. A small incision (cut) will be made to open and drain fluid from your infected cyst.
  • Injections Injections (phenol, an acidic chemical compound) can treat and prevent mild and moderate pilonidal cysts.
  • Antibiotics Antibiotics can treat skin inflammation. However, antibiotics can’t heal pilonidal cysts on their own.
  • Laser therapy Laser therapy can remove hair which otherwise might become ingrown and cause more pilonidal cysts to come back.
  • Surgery to remove the cyst Complex or recurrent disease must be treated surgically. Procedures may vary from unroofing the sinus to excising the cyst and possible closure utilizing different types of flaps. If the wound is left open, it will require dressing care and take longer to heal. Your surgeon will discuss your surgical options with you.

It is important that the skin in the buttock crease area be kept clean and free from hair. This can be accomplished with shaving or laser treatment.

While awaiting treatment, pain can be managed by using a warm compress on the affected area. An inflatable seat or mattress can provide comfort.