Pilonidal disease

What is a pilonidal sinus?

A pilonidal sinus is an inflammation which develops in the crease of skin formed at the lower part of the back just above the buttocks. It is caused by hairs which become embedded in the skin setting up a chronic inflammatory response. Although the disease can occur in women, it usually presents in males with thick body hair below the age of 40. Symptoms vary from a small unnoticed dimple to a large abscess. Commonly the area leaks cloudy or occasionally bloodstained fluid and may becomes infected leading to the development of a hot, red, painful lump which discharges pus.

Most patients will develop an infection at some time. This usually requires antibiotics to treat it but may require surgery to “lance” the abscess and allow the pus to drain away. Following this a fine tract forms which leads away from the skin into the deeper tissues. These sinuses may constantly discharge fluid, are prone to recurrent infection and usually require a surgical procedure to remove them. A wide variety of surgical procedures exist to deal with pilonidal sinus’ and range from removing the area and leaving it to heal by itself to complicated closure with plastic surgery procedures. After surgery infection is common and may lead to recurrence of the sinus, necessitating further surgery. The exact choice of which surgical procedure is appropriate should be discussed with your surgeon.

What care is required after surgery?

If the wound is closed it will need to be kept clean and dry until the skin is completely healed. However if the wound is left open or subsequently becomes infected, regular, daily dressing will be needed to help the wound to heal correctly. This may take several weeks to achieve and may limit regular activities. After healing it is advisable to maintain the skin in the buttock crease free from hair to reduce the risk of recurrence. This can be done by using hair removal creams every few weeks or shaving the area regularly. By the time patients reach their early 30’s the hairs become softer and the cleft between the buttocks become less deep reducing the need for this intense skin care.