Pilonidal Disease

Cause

The cause of pilonidal disease is not clear. Loose hairs pushing into the skin may cause the disease. Small holes that hold each hair in the skin are called hair follicles. Pressure and friction on follicles can make them move. This causes hair to grow into the skin (ingrown hair). This is more common after puberty, when hair grows more and skin makes more oils.

Risk Factors

Pilonidal disease is more common in patients born male between 13 and 26 years old. You’re more at risk if: 

• One or more family members has had this condition.
• You have poor hygiene. 
• You are overweight.
• There is a lot of hair around the sinus, or the hair is coarse or curly.
• There is a deep crack (gluteal cleft) in the buttocks.
• You sit more than 6 hours each day. 
• The shape and curve of the buttock is abnormal.
• You had an injury to the affected area before.

Signs and Symptoms

It’s common to not have symptoms with a pilonidal sinus until it’s infected. However, symptoms can develop fast and can get worse without treatment. If there’s an infection, a pocket of pus (abscess) may form. Symptoms of an infected pilonidal sinus include:

• Pain
• Fever
• Red skin
• A tender lump under the skin, usually near the tailbone
• Pain in thee area that makes it hard to get comfortable when you sit or lie down
• Blood or pus coming out of (draining) from the sinus

Treatment

To keep a pilonidal sinus from getting infected, keep the area as clean and dry as possible. Hair and lint can collect in between the buttock cheeks. Take a bath or shower each day, making sure you wash and dry this area well.

There are a few ways to treat pilonidal disease. Your surgeon will be able to give you the details and discuss each treatment. The options include:

• Antibiotics – If an infection is found early, antibiotics can keep it under control and stop the infection.
  • If the pilonidal sinus stays infected, you may need to have it removed.
  • If you feel pain and think the disease is returning, contact your doctor or health care provider right away.
• Incision and drainage with antibiotics – Along with antibiotics, a cut (incision) is made to drain the sinus.
  • After opening the infected sinus, a small straw-like drain is put in the sinus to remove any pus. The drain is held in place by stitches (sutures). It will usually fall out on its own in about 1 week. However, you may need to return to have the drain removed. This is a short procedure that can be done at the Nationwide Children’s clinic.
  • A dry bandage (dressing) is placed over the incision site to collect any drainage. The dressing needs to be changed each day. You will learn how to do this.
  • Most people can go home after this procedure.
• Minimally invasive surgery – During surgery, the pilonidal pits and connecting sinus tracts are removed and cleaned out. The area will be kept open to drain. A small gauze dressing is put on the area to collect drainage. After surgery, your child:
  • Can go back to their daily activities.
  • Should sleep on their stomach.
  • Must wash their surgical site 2 to 3 times each day with a mild, fragrance-free soap.
  • Should remove hair after the surgical site has healed.
  • Can get this disease again.

Healing

If you don't need surgery, follow the instructions below to help with healing.

Nutrition

• Eat 2 to 3 grams (g) of protein or each kilogram (kg) of your body weight each day. For example, if you weigh 80 kg, eat 160 to 240 g of protein each day.
• Your weight in kg is on your after-visit summary (AVS).
• Examples of foods with protein are beans, eggs, cottage cheese, almonds, chicken breast, lean beef, and tuna.
• Eat less sugar. Instead, eat 7 to 10 servings of fruits and vegetables each day.
• Try a food-tracking app to track what you eat.

Vitamins - Take a daily multivitamin with 100% recommended daily allowance of zinc.

Saltwater baths - Add 1 cup of salt in 1 foot (12 inches) of warm water in a tub. Soak in it for 20 minutes two times each day.

Decrease pressure on wound 

• Avoid sitting as much as possible. Stand more often.
• Lie down when possible.
• When sitting, perch on the front of your chair while leaning forward. This will help keep pressure off the wound.

Keep dry

• Place dry gauze (folded in half) in gluteal cleft.
• Change the gauze to keep the area dry as needed.

Preventing Another Infection

There are 2 ways to get rid of extra hair and keep it from growing back:

• Hair removal and careful hygiene
  • Remove hair every other week to keep pilonidal disease from coming back. Use a razor by shaving or use a hair removal cream like Nair™. Do not use lotion.
  • Do not shave or use hair removal cream if you have an open wound without talking with your doctor or healthcare provider first.
  • Shower right after sports or when you’re hot and sweating. Washing the infected area with soap and a washcloth helps keep it clean.
• Laser hair removal - A light (laser) is used to remove hair roots (follicles). It lasts longer than shaving or using hair removal cream.
  • Laser therapy is done over a few outpatient sessions at the surgery clinic. It depends on your child’s hair color and thickness and their skin type. Their doctor or health care provider will likely recommend 5 to 6 treatments. Treatments are done at least
    4 weeks apart.
  • They will wear protective eye shields and a mask during treatment.
  • They will have the option to use numbing cream on the area of their body being treated. The cream needs to stay on for 30 minutes to work.
  • A wand will be held against their skin where unwanted hair is. The wand will pulse, which feels like a rubber band snapping against the skin. The tip of the wand has a chill tip that cools the skin during treatment. This may help reduce pain.
  • Before laser hair removal, your child:
    • Cannot use a tanning bed for at least 2 weeks.
    • Should not remove hair by waxing.
    • Must keep the area being treated clean and dry.
    • May cool their skin right after treatment. This may help with pain.
    • Must avoid tight clothing.
    • Can use Aquaphor^® ointment on the treated area. This may help the area feel better and reduce redness.
    • Needs a list of all medicines they take. Some medicines may cause a reaction to laser therapy.
  • Side effects for laser therapy include: bleeding, blistering, and pain that takes a while to go away.

 

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