Pilonidal disease is a common condition that affects the natal cleft of the buttocks. The natal cleft is the groove extending from the sacrum to the perineum. It commonly affects younger men and women and varies in severity depending on the size and location of the disease.
Symptoms:
Pathogenesis:
Prolonged sitting can cause hair shed from the head, back, or natal cleft region to become trapped or embedded in the natal cleft. When sitting, a potential space is created between the folds of the natal cleft. Upon standing or moving, a negative pressure vacuum effect can draw loose hairs into the skin pores. Friction exacerbates this process, allowing the hairs to form a sinus. The body reacts to the trapped hair as a foreign body, leading to either an acute abscess or a chronic cavity.
Management:
Addressing modifiable lifestyle risk factors is key to managing pilonidal disease. Non-operative measures include laser hair removal from the back to prevent shedding and hair entrapment in the natal cleft.
Surgical intervention is necessary in the acute setting for abscess drainage. Definitive surgical options include:
Each treatment option is carefully tailored to the patient. In some cases, multiple treatment sessions may be required to fully resolve pilonidal disease.
