What is pilonidal disease?
Pilonidal disease is a chronic skin infection in the crease of the buttocks near the coccyx (tailbone). It affects about 70,000 people in the US annually and is more common in men than women. Most often it occurs between puberty and age 40. People who are overweight and who have thick, stiff body hair are more likely to develop pilonidal disease.
What causes pilonidal disease?
The cause for pilonidal disease is not completely understood. Hair often grows in the cleft (crease) between the buttocks. These hairs can traumatize and penetrate the skin at the top of the buttock crease. Hairs can get caught under the skin in this area. This can result in irritation, infection, and formation of an abscess.
What symptoms does pilonidal disease cause?
Symptoms can vary from very mild to severe. The symptoms may include:
How do patients find out that they have pilonidal disease?
Nearly all patients are initially diagnosed by having an acute abscess episode (the area is swollen, tender, and pus may drain from it). After the abscess goes away, either by itself or with medical care, many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface through one or more small openings (pits). Some sinus tracts may resolve on their own, however, most patients need minor surgery to remove them. Diagnosis is typically confirmed by a physician examining the buttock area.
How is pilonidal disease treated? Do I need surgery?
Treatment depends on the disease pattern, and not everyone needs surgery. Once diagnosed and any active inflammation or infection is taken care of the primary therapy is keeping the area free of hair (topical depilatories, shaving, laser hair removal). The treatment for an abscess is drainage. An incision is made that allows pus to drain, reducing inflammation and pain. This procedure can usually be done in a physician’s office using local anesthetic. If there is significant inflammation of the skin antibiotics may be prescribed. Keeping hair out of the area (shaving, laser, etc.) can be utilized to help treat both active and chronic disease.
What does surgery involve?
Complex or recurring infections are treated surgically, either through excision or unroofing (opening) the sinuses. Unroofing the sinuses involves opening up the abscess and tracts and trimming the edges of skin.
Operations with complete excision of tracts and any abscess cavity often result in better long-term outcomes, although healing takes longer. Closure with flaps (moving healthy body tissue into the area) has a greater risk of infection, but may be required in some patients. Some of the surgeons at Sacramento Colon & Rectal Surgery are performing the cleft lift flap closure procedure. This is a newer procedure that has been developed over the last 15 years and demonstrates faster healing and lower rates of recurrence. Your surgeon will discuss all the options and help you choose the most appropriate surgery.
How likely is it that pilonidal disease will come back after surgery?
When the wound is closed, it must be kept clean, dry and free of hair until the skin is fully healed. If the wound is left open, dressings or packing are used to help remove secretions and allow the area to heal from the bottom up.
After healing, the skin in the buttocks crease must be kept clean and free of hair. It is necessary to shave or use a hair removal agent every 2 or 3 weeks until the age of 30. After that age, hair shafts thin out and soften and the depth of the buttock cleft lessens. Pilonidal disease can be a chronic, recurring condition so it is important to follow your physician’s postsurgical care instructions. The goal of the surgeons at Sacramento Colon & Rectal Surgery Medical Group is to give you the best chance at long-term healing from your pilonidal disease.