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Pilonidal disease

Pilonidal disease

Pilonidal disease is a type of infection of the skin and subcutaneous tissue which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end.

A pilonidal cyst is a cyst in the sacral region between the dermal layer of fat and muscle fascia. It is located near the tailbone at the top of the cleft of the buttocks.

Pilonidal sinus is a small channel which originates from the source of infection and opens to the surface of the skin. Material from the cyst often drains through the pilonidal sinus.
It might be of congenital origin or might be linked to ingrown hair.
An abscess could develop due to continuous micro-traumas (as in seated position) that create chronic inflammation. This abscess tends to empty the pus through a skin opening orifice. Usually, the disease, typical of young age, is characterized by periods of remission alternating with episodes of exacerbation.
Signs and symptoms of an infected pilonidal cyst include:

  • Pain
  • Reddening of the skin
  • Drainage of pus from an opening in the skin
  • Foul smell from draining pus
  • Drainage of blood from an opening in the skin

Predisposing factors for the development of pilonidal cyst include obesity, inactive lifestyle, occupation requiring prolonged sitting, excess body hair, and younger age.


If there is a sign of infection, treatment is generally by incision and drainage just off the midline. After the inflammation and the infection are under control, a second surgical step could be scheduled.
The operation aims to remove the pilonidal cyst because it hardly ever heals spontaneously. Spinal anaesthesia is the most common type of anaesthesia used to perform this kind of surgery. Antibiotic prophylaxis is usually necessary. The surgery consists of complete removal of cysts and fistulas.
Sometimes it is impossible to know the real extent of the fistula before the surgery; therefore decisions are made during the operation. In some cases, the excision may become large as to make the closure of the skin difficult or suture may be contraindicated due to persisting of inflammatory process.
Postoperative pain is generally mild. Discharge usually takes place from 1 to 2 days after surgery.
Early ambulatory is advised after the surgery, but heavy work and sports activities must be avoided for 4-6 weeks.
Recurrence: cyst may recur after a variable time, even after years, but this rarely occurs.