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Pilonidal Disease

HH-I-440 | Revised 11/20 | Copyright 2018, Nationwide Children’s Hospital

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Pilonidal (pie luh NY dul) disease is a condition that affects mainly teenagers and young adults. A pilonidal sinus is a small hole that occurs under your skin between your buttock cheeks, where the buttocks separate. There may be more than one sinus. This is common. These may be connected by tunnels under the skin. You may not see a pilonidal sinus unless it is infected.

Cause

The exact cause of pilonidal disease is not clear. There are many ways the condition can occur. Pilonidal sinus is typically caused by loose hairs pushing into the skin. Hair follicles are the small holes that hold each hair in the skin. Pressure and friction on hair follicles can move the follicles, causing the hairs to grow into the skin rather than outward. This does not typically become a problem until puberty when hair growth and oil production increase in the skin.

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Risk Factors

Pilonidal disease affects more males than females. It typically occurs between the ages of 13 and 26 years. The following are some things known to increase your risk of pilonidal disease:

  • One or more family members has had this condition
  • A lot of body hair surrounds the sinus
  • Hair is coarse or curly
  • There is a deep gluteal cleft (deep crack in the buttock)
  • Over six hours per day is spent sitting
  • Shape and curve of the buttocks
  • Previous injury to the affected area
  • Poor hygiene
  • Overweight

Signs and Symptoms

You may have a pilonidal sinus and not have any noticeable symptoms. However, in many cases it will get infected. If the sinus becomes infected, an abscess will usually develop. An abscess is a collection of pus that forms in and around the sinus. Symptoms of an infected pilonidal sinus are:

  • Pain
  • Red skin
  • Fever
  • Drainage of blood or pus from the sinus
  • A tender lump under the skin, usually near the tailbone

Symptoms can develop quickly and will likely get worse without treatment. Pain in the area will make it difficult to sit or lie down comfortably.

Treatment

To keep a pilonidal sinus from being infected it is very important to keep the area as clean and dry as possible. Hair and lint can collect in between the buttock cheeks. Bathe every day, making sure to wash and dry this area well to avoid infection.

There are various treatments that can be done to treat pilonidal disease. Your surgeon will be able to give you the details and discuss each treatment. These are the options:

Antibiotics

If you have a rapid onset of symptoms, you may be given antibiotics to keep the infection under control. If an infection is found early, sometimes antibiotics alone can stop it. If the pilonidal sinus stays infected, surgery may be needed to remove the sinus.

If you feel pain and think the disease is returning, contact your doctor right away.

Incision and Drainage With Antibiotics

If symptoms start quickly, antibiotics are started and a cut (incision) is made to drain the sinus. The doctor opens the infected sinus and inserts a small straw-like drain to remove the pus. The drain is held in place by stitches (sutures). The drain will usually fall out on its own in about a week. Depending on how the procedure is done, you may need to return to have the drain removed. This is a short procedure that can be done at the hospital or urgent care.

Afterward, a dry dressing is applied to collect any drainage. The dressing needs to be changed each day. You will be taught how to do this. Most people can go home after the drainage procedure.

Minimally Invasive Surgery

This surgery, known as trephination or the Gip’s procedure, involves the removal and cleaning of all the pilonidal pits and connecting sinus tracts. During the procedure, the doctor looks to see how deep the sinus tracts are and where they go. Once the tracts are found, the diseased tissue is removed. After the surgery, the openings stay open to drain. A small gauze dressing is applied to the area to collect the drainage. Your child may resume daily routine activities. Your child should sleep on their stomach and wash their surgical site a few times a day using a mild, fragrance free soap. Additionally, regular hair removal in the area is strongly recommended.

Excision and Reconstruction Using a Flap 

Sometimes called the Cleft procedure, this surgery removes all the skin covering the involved area. Then, the surgical wound is closed by rotating other tissue to cover the area. The rotating of tissue causes the gluteal cleft to shift. This means that the butt crack will appear off-center. This is not noticed when your child has on clothing. This surgery is done by a plastic surgeon and is typically done on patients who have severe disease.

The chance of getting this disease again after treatment is 20 to 50 percent. Good personal hygiene is very important to help reduce this risk.. You need to keep the wound clean and free of any hair growing near the area. Even when the wound is healed, you should keep the area free of hair since excess hair greatly increases the risk that the condition will come back.

Preventing Another Infection

To get rid of excess hair and keep it from growing back in the area of the infected sinus, there are two options.

Hair Depilation and Careful Hygiene

Hair removal (depilation) every other week with either a razor (shaving) or a depilatory cream such as Nair™ is effective in keeping pilonidal disease from coming back. Showering right after sports or other activities when you are hot and sweating is typically recommended. Daily showering and washing the area with soap and a washcloth gives gentle, daily exfoliation to the area and keeps it clean. Do not shave or use depilatory cream if you have an open wound without asking your doctor

Laser Hair Removal 

Laser hair removal is a longer lasting treatment for removing body hair. It usually involves several sessions of laser therapy in the clinic. It has been shown to be an effective method to prevent or lower the chance of pilonidal sinus disease from recurring. Most insurance plans do not cover the cost of using lasers for the medical treatment of pilonidal disease. They consider laser treatment to be a cosmetic procedure.

Studies have found that laser hair removal greatly reduces the recurrence rate of pilonidal sinus disease. If you would like to take part in a clinical trial for laser hair removal, please contact us at 614-722-3909.

Pilonidal Disease (PDF)

HH-I-440 | Revised 11/2020 | Copyright 2018, Nationwide Children’s Hospital

NEXT STEPS
Use our secure online form to request an appointment with our experts or get a second opinion. An appointment scheduler will contact you by phone within 24 hours.

Research 

A number of studies have found that laser hair removal greatly reduces the recurrence rate of pilonidal disease. Drs. Minneci and Deans, pediatric surgeons at Nationwide Children’s Hospital, are currently conducting a study that will help better understand how laser hair removal can help patients, 11-21 years old, with pilonidal disease.

Participants of the study will be randomly assigned to receive laser hair removal or standard care. All participants will be followed through 1 year of treatment and will be compensated for the completion of each follow-up, at 1, 2, 3, 4, 5, 6, 9, and 12 months after enrollment. Those that are not originally assigned to receive the laser will be offered laser hair removal treatments, free-of-charge, after their 12-month follow-up has been completed. If you are interested in participating in this a clinical trial for laser hair removal please contact us.

Contact Information

Call or text a study member at (614) 580-2828, (614) 722-0742 or email Leah.Nishimura@NationwideChildrens.org.