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Pilonidal sinus disease

Pilonidal abscess; Pilonidal sinus; Pilonidal cyst; Pilonidal disease

 

Pilonidal sinus disease is am inflammatory condition involving the hair follicles that can occur anywhere along the crease between the buttocks, which runs from the bone at the bottom of the spine (sacrum) to the anus. The disease is benign and has no association with cancer.

Pilonidal dimple may appear as:

  • A pilonidal abscess, in which the hair follicle becomes infected and pus collects in the fat tissue
  • A pilonidal cyst, in which a cyst or hole forms if there has been an abscess for a long time
  • A pilonidal sinus, in which a tract grows under the skin or deeper from the hair follicle
  • A small pit or pore in the skin that contains dark spots or hair

Considerations

 

Symptoms may include:

  • Pus may drain to a small pit in the skin
  • Tenderness over the area after you are active or sit for a period of time
  • Warm, tender, swollen area near the tailbone
  • Fever (rare)

There may be no symptoms other than a small dent (pit) in the skin in the crease between the buttocks.

 

Causes

 

The cause of pilonidal disease is not clear. It is thought to be caused by hair growing into the skin in the crease between the buttocks.

This problem is more likely to occur in people who:

  • Are obese
  • Experienced trauma or irritation in the area
  • Have excess body hair, particularly coarse, curly hair

 

Home Care

 

Wash normally and pat dry. Use a soft bristle scrub brush to prevent the hairs from becoming ingrown. Keep the hairs in this region short (shaving, laser, depilatory) which may decrease risk of flare-ups and recurrence.

 

When to Contact a Medical Professional

 

Call your health care provider if you notice any of the following around the pilonidal cyst:

  • Drainage of pus
  • Redness
  • Swelling
  • Tenderness

 

What to Expect at Your Office Visit

 

You will be asked for your medical history and given a physical examination. Sometimes you may be asked for the following information:

  • Has there been any change in the appearance of the pilonidal sinus disease?
  • Has there been any drainage from the area?
  • Do you have any other symptoms?

Pilonidal disease that causes no symptoms does not need to be treated.

A pilonidal abscess may be opened, drained, and packed with gauze. Antibiotics may be used if there is an infection spreading in the skin or you also have another, more severe illness.

Other surgeries that may be needed include:

  • Removal (excision) of the diseased area
  • Skin grafts
  • Flap operation following excision
  • Surgery to remove an abscess that returns

 

 

References

Coates WC. Disorders of the anorectum. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 96.

Ferri FF. Pilonidal disease. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier; 2016:963.

Kliegman RM, Stanton BF, St Geme JW, Schor NF. Surgical conditions of the anus and rectum. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 344.

Sternberg JA. Management of pilonidal disease. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:293-401.

 
  • Anatomical landmarks, back view

    Anatomical landmarks, back view - illustration

    There are three body views (front, back and side) that may be helpful if you are uncertain of a body area. Many areas are referred to by both descriptive and technical names. For example, the back of the knee is called the popliteal fossa. However, areas like the "flank" may not have both names, so the location may be unclear.

    Anatomical landmarks, back view

    illustration

  • Pilonidal dimple

    Pilonidal dimple - illustration

    A pilonidal dimple is a small pit or sinus in the sacral area just at the top of the crease between the buttocks. The pilonidal dimple may also be a deep tract, rather than a shallow depression, leading to a sinus that may contain hair. During adolescence the pilonidal dimple or tract may become infected forming a cyst-like structure called a pilonidal cyst. These pilonidal cysts may require surgical drainage or total excision to prevent reinfection.

    Pilonidal dimple

    illustration

    • Anatomical landmarks, back view

      Anatomical landmarks, back view - illustration

      There are three body views (front, back and side) that may be helpful if you are uncertain of a body area. Many areas are referred to by both descriptive and technical names. For example, the back of the knee is called the popliteal fossa. However, areas like the "flank" may not have both names, so the location may be unclear.

      Anatomical landmarks, back view

      illustration

    • Pilonidal dimple

      Pilonidal dimple - illustration

      A pilonidal dimple is a small pit or sinus in the sacral area just at the top of the crease between the buttocks. The pilonidal dimple may also be a deep tract, rather than a shallow depression, leading to a sinus that may contain hair. During adolescence the pilonidal dimple or tract may become infected forming a cyst-like structure called a pilonidal cyst. These pilonidal cysts may require surgical drainage or total excision to prevent reinfection.

      Pilonidal dimple

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Pilonidal sinus disease

           

             

            Review Date: 2/23/2016

            Reviewed By: Todd Campbell, MD, FACS, Clinical Assistant Professor, RowanSOM, Department of Surgery; Inspira Medical Group Surgical Associates, Elmer, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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