Pilonidal disease

Anatomical landmarks, back view

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.

Also known as: Pilonidal abscess, Pilonidal sinus or Pilonidal cyst

Definition

Pilonidal disease is a condition 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.

Pilonidal disease 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

Common 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
  • Sit for long periods of time
  • Wear tight clothing

Home Care

It may help to keep the area clean and dry and remove hair regularly to prevent infection.

Call your health care provider if

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 health care provider's office

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 cyst?
  • Has there been any drainage from the area?
  • Do you have any other symptoms?

Rarely, a CT scan is done.

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
  • Surgery to remove an abscess that returns

References

Klein MD, Thomas RP. Surgical conditions of the anus, rectum, and colon. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 341.

Nelson H, Cima RR. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 51.

Humphries AF, Duncan JE. Evaluation and management of pilonidal disease. Surg Clin North Am. 2010;90:113-124.

See also:

Review date:
December 17, 2010
Reviewed by:
Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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