Pilonidal disease is a chronic skin infection in the crease of the buttocks near the coccyx (tailbone). It is more common in men than women and most often occurs between puberty and age 40. Obesity and thick, stiff body hair make people more prone to pilonidal disease.
It is an acquired disease and not a congenital.
Cause is hairy skin and prolonged sitting posture commonly encountered in Drivers due to continuous friction. It begins with a brawny swelling at the back on either side of gluteal cleft which bursts open and later on forms a sinus. Contents of this sinus are dead hair of our body.
Hairs often grow in the cleft between the buttocks. These hair follicles can become infected. Further, hair can be drawn into these abscesses worsening the problem.
Symptoms can vary from very mild to severe. The symptoms may include:
Nearly all patients have an acute abscess episode (the area is swollen, tender and pus may drain from it). After the abscess goes away, either by itself or with medical care, many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface through one or more small openings. Some sinus tracts may resolve on their own, however, most patients need minor surgery to remove them.
Diagnosis is typically confirmed by a physical examination of the effected area.
Treatment depends on the disease pattern. The primary treatment for an acute abscess is drainage. An incision is made that allows pus to drain, reducing inflammation and pain. This procedure can usually be done in a physician’s office under local anesthesia.
Complex or recurring infections must be treated surgically, either through excision or unroofing the sinuses. Unroofing the sinuses, as shown in Figure 2, involves opening up the abscess and tracts and trimming the edges of skin.
Figure 2: Drawing B shows inflammation located deep under the skin above the tailbone. The dashed line indicates the area to be opened or unroofed. The dashed line in drawing C shows the entire inflamed tissue that will be removed.
The openings are probed and the sinus cavity is scooped to clear all infected material then radial fiber of diode laser is introduced inside the cleaned tract to ablate the sinus tract completely giving promising results. Good cosmesis is achieved in female patients.
After healing, the skin in the buttocks crease must be kept clean and free of hair. It is necessary to shave or use a hair removal agent every 2 or 3 weeks until the age of 30. After that age, hair shafts thin out and soften and the depth of the buttock cleft lessens. Pilonidal disease can be a chronic, recurring condition so it is important to follow postsurgical care instructions.