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Pilonidal Disease

By Parswa Ansari, MD, Assistant Professor and Program Director in Surgery, Hofstra Northwell - Lenox Hill Hospital, New York

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Pilonidal disease refers to an acute abscess or chronic draining sinus in the sacrococcygeal area.

Pilonidal disease usually occurs in young, hirsute, white males but can also occur in women. One or several midline or adjacent-to-the-midline pits or sinuses occur in the skin of the sacral region and may form a cavity, often containing hair. The lesion is usually asymptomatic; infected lesions are painful.

Treatment of an acute abscess is by incision and drainage. Usually, one or more chronic draining sinuses persist and must be extirpated by excision and primary closure or, preferably, by an open technique (eg, cystotomy, marsupialization). Antibiotics are typically not needed.

Larger cysts may require a rotation flap to close the defect.

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