Pilonidal Disease

Definition
Pilonidal disease is a skin infection that causes a cyst or growth containing hair and debris to develop between the buttocks. Typically, pilonidal cysts are located near the tailbone above the cleft of the buttocks. This condition is common in individuals with excess body hair and is more common in men than women. Pilonidal cysts develop when hair becomes trapped under the skin and becomes infected, resulting in chronic inflammation and a painful abscess. Treatment for pilonidal disease usually depends on the disease pattern, but most patients require either drainage or excision of the pilonidal cyst. 

Causes
Although the exact cause of pilonidal disease is unknown, it appears loose hairs that become embedded and infected within the skin generally cause this condition. Friction and tension in between the buttocks while walking, sitting for extended periods of time, wearing tight clothing, or exercising (i.e. running, bicycling, etc.) may also cause pilonidal cysts to form above or between the crease of the buttocks. 

Risk Factors
Pilonidal disease is most common in men and people with a great deal of body hair. For these individuals, pilonidal cysts have a tendency to recur. Other risk factors include professions that require prolonged sitting and occupations that deal with foreign or loose hair. Due to the nature of their profession, barbers, hairstylists, dog groomers, and sheep shearers are often at risk of developing pilonidal cysts in between their fingers.

Symptoms
Symptoms of pilonidal disease can range from asymptomatic to symptoms that cause chronic inflammation and pain. For the most part, patients with pilonidal disease experience the following symptoms:

  • A small dimple or large mass, depending on the disease pattern
  • Infection within the cyst that causes redness, tenderness, and drainage
  • Drainage (pus) that has a foul order, is clear, cloudy, or bloody
  • On rare occasions, fever or nausea may be present 

Treatments
Treatment for pilonidal disease varies depending on the disease pattern of the cyst. An acute abscess is usually treated in an outpatient setting with a local anesthesia to minimize discomfort. In these cases, a physician will make an incision to drain the pus and reduce inflammation. Pilonidal cysts that are chronic or recurrent are usually treated surgically by excising the cyst and closing them after drainage, or by leaving the surgical site open to promote healing. A colon and rectal surgeon will discuss these options with you during the initial evaluation. 

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