Merck Manual

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Pilonidal Disease

By

Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York

Full review/revision Jan 2023
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Topic Resources

Pilonidal disease is a disorder that occurs when a hair grows into the skin at the top of the cleft between the buttocks.

  • This disorder occurs when hairs near the buttocks grow into the skin.

  • If an infection develops, symptoms include pain, redness, and swelling and sometimes pus.

  • The diagnosis is based on an examination.

  • Treatment includes measures to remove abscesses and sinuses and repair cysts.

Pilonidal disease usually occurs in young, hairy, White men but can also occur in women.

For unknown reasons, sometimes a hair irritates and grows into the skin, forming a cavity that may contain hair. Such a cavity is called a pilonidal cyst and typically forms at the top of the cleft between the buttocks. A pilonidal cyst may cause no symptoms, or it may become infected and cause pain.

If an infection causes a collection of pus to form, it is called a pilonidal abscess. A pilonidal abscess causes pain, redness, and swelling. Sometimes pus drains spontaneously from the abscess.

A pilonidal sinus is a chronic draining wound at the site.

Diagnosis of Pilonidal Disease

  • A doctor's examination

To distinguish pilonidal disease from other infections, a doctor looks for tiny holes in or next to the infected area (pits).

Treatment of Pilonidal Disease

  • For pilonidal abscesses, cutting and draining

  • For pilonidal sinuses, surgical removal

  • For larger cysts, flap procedure

Generally, a pilonidal abscess must be cut and drained by a doctor. Antibiotics are typically not needed.

Usually, a pilonidal sinus must be removed surgically.

Larger cysts may need to be closed with a flap procedure. In a flap procedure, skin and sometimes muscle are moved from a nearby area to cover the area that the cyst was removed from.

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