Pilonidal disease

Pilonidal disease is a chronic skin condition that occurs in the area of the buttocks crease. The disease is characterized by small pits or sinuses in the skin, which may become infected and form painful abscesses.

Pilonidal abscess

Etiology

The exact cause of pilonidal disease is not known, although it is thought to be caused by loose hairs that penetrate the skin, causing inflammation and infection. Factors such as prolonged sitting, obesity, local trauma, or poor hygiene can increase the risk of developing this disease. It is more common in men than in women and typically occurs in younger adults.

Pilonidal Cyst

Pilonidal cyst 2 days after surgery

Pathophysiology

The disease begins when hair penetrates the skin, which can lead to the formation of a sinus tract under the skin. This area may then become infected, usually by bacteria, and form an abscess. Over time, the disease can progress and cause multiple interconnected sinus tracts and abscesses.

Clinical Presentation

Symptoms of pilonidal disease include pain, redness, and swelling in the area of the buttocks crease. A visible pit or small hole may be present in the skin. If an abscess forms, it may cause severe pain and may drain pus or blood.

Diagnosis

The diagnosis of pilonidal disease is usually made based on physical examination. Imaging tests, such as ultrasound or MRI, can be used to determine the extent of the disease, especially if multiple sinus tracts are suspected.

Treatment

• Treatment of pilonidal disease depends on the severity of the disease and whether an abscess is present. If an abscess is present, the initial treatment usually involves draining the abscess to relieve symptoms.
• Chronic pilonidal disease or recurrent abscesses may require surgery. The most common surgical procedure is excision of the sinus tracts, although other surgical techniques may be used depending on the extent of the disease.
• After surgery, proper wound care and hair removal techniques are crucial to prevent recurrence of the disease.

Prognosis and Prevention

• With proper treatment, most people with pilonidal disease can fully recover. However, the disease can recur if hair continues to penetrate the skin.
• Preventive measures include maintaining good hygiene in the area, regular hair removal (such as shaving or using hair removal creams), and avoiding prolonged sitting or activities that cause friction or pressure on the area.

See Also

• Skin abscess
• Chronic wound

References

• Bascom, J., & Bascom, T. (2002). Utility of the cleft lift procedure in refractory pilonidal disease. The American Journal of Surgery, 183(5), 587-591.
• McCallum, I. J., King, P. M., & Bruce, J. (2007). Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. The Cochrane Database of Systematic Reviews, (4), CD006213.

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