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What Is Pilonidal Disease?
Pilonidal disease is an extremely common condition among teenagers and young adults. It is a problem that develops in the gluteal cleft, or the crease between the buttocks. It occurs most often in teenagers when they start to have more body hair growth in the area.
Other names for pilonidal disease include pilonidal cyst and sacrococcygeal disease.
This chronic health issue causes cysts or abscesses along the buttock crease. These cysts form when hair and skin debris become trapped in small pits beneath the skin. The disease can cause recurrent infections, pain, and drainage.
Pilonidal cysts start with tiny holes (pilonidal pits) in the skin. When hair gets trapped within these holes, it causes chronic irritation. This irritation creates a larger cavity under the skin called a pilonidal cyst.
When the cyst becomes infected, it looks like a giant pimple. It will be a large, red, swollen, painful bump that may be draining puss. These infections can be chronic and may take a long time to heal because of the location.
While not typically life-threatening, severe cases can be debilitating. This condition can impair daily activities due to pain and ongoing care. These cysts may require surgery.
What are the types of pilonidal disease?
Types of pilonidal disease include:
- Pilonidal sinus — This is the most common type. It's a small tunnel or sinus tract in the skin near the cleft of the buttocks. It can lead to recurrent abscesses and drainage.
- Pilonidal cyst — In this type, a cyst forms beneath the skin in the sacrococcygeal (tailbone) area. It can become infected, leading to pain, swelling, and drainage of pus.
- Pilonidal abscess — When the cyst or sinus becomes infected and filled with pus, it forms an abscess. The infection can cause intense pain, redness, and fever.
What causes pilonidal disease?
Pilonidal disease develops when hair follicles in the buttock crease become irritated or inflamed. Hair can burrow into the skin, forming small pits or cysts.
Friction from activities like sitting or clothing rubbing against the skin makes it worse. Once hair becomes trapped, it can lead to infection, abscess formation, and chronic inflammation.
What are pilonidal disease risk factors and complications?
The clogging of tiny pits causes pilonidal disease. So, the biggest risk factors are the presence of pits and, most importantly, how hairy the area is.
Pilonidal disease risk factors
Pilonidal disease primarily affects young adults, especially males. It is often associated with a family history of similar issues.
Common risk factors include:
- Excessive sweating — Sweating a lot may raise the risk of pilonidal disease.
- Genetic predisposition — Some people may have a genetic predisposition to developing pilonidal disease, although specific genetic factors are not well-defined.
- Hair entrapment — The primary cause is hair entering and getting trapped in the buttock crease, where friction and moisture can irritate.
- Poor hygiene — Inadequate cleaning of the buttock crease area can lead to a buildup of debris, leading to pilonidal disease.
- Obesity — A higher BMI can raise the risk due to higher friction and sweat in the buttock crease.
- Sedentary lifestyle — Extended sitting or lack of physical activity can raise pressure and friction, worsening the condition.
Complications of pilonidal disease
Pilonidal disease is chronic and can be serious if not managed properly. Infections that keep coming back can lead to long-term complications if left untreated. Though not life-threatening, pilonidal disease requires constant upkeep and can impact daily life.
Complications include:
- Abscess formation — Untreated infections can become abscesses, requiring drainage and antibiotics.
- Cellulitis — This skin infection can develop if a pilonidal cyst infection spreads to nearby tissue.
- Chronic infections — Infections of the pilonidal cyst that return can lead to chronic pain and discomfort.
- Difficulty sitting — Severe cases may result in discomfort or pain while sitting, affecting daily activities and quality of life.
- Sinus tracts — Pilonidal sinuses or tracts can develop, causing lasting drainage and raising the risk of further infections.
How can I reduce my child's risk of pilonidal disease?
The easiest way to reduce the risk of pilonidal disease is to maintain good hygiene practices, especially in the buttock crease area.
- Avoid prolonged periods of sitting to reduce pressure and friction in the buttock area.
- Consider hair removal from the gluteal cheeks and lower back.
- Keep the gluteal crease clean and dry.
- When washing, use a clean cloth and careful scrubbing techniques to remove debris, lint, and hair buildup.
How common is pilonidal disease?
Pilonidal disease is relatively common, especially among teenagers with more body hair in the buttock crease. It can affect many people, particularly those prone to hair trapping and recurrent infections.
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What Are the Symptoms of Pilonidal Disease?
Symptoms of pilonidal disease include pain, redness, and drainage in the buttock crease area. Patients may have recurrent infections due to trapped hair.
The infection starts with pain or soreness in the gluteal cleft. There may be redness or swelling after that. This pain gets worse over time.
The swelling is a collection of pus and the formation of an abscess. The abscess may burst and drain pus and start to feel better. Other times, it gets worse, and you may need to go to a doctor to have it drained.
When abscesses first appear, people are often confused by the pain. They think maybe they hit themselves and have a bruise, as most patients are active. Other people may have some blood on a sore or an opening that keeps leaking pus.
There may be:
- Physical symptoms — Painful cysts or abscesses in the buttock crease may drain pus or blood. Symptoms include redness, swelling, and tenderness in the affected area.
- Emotional and mental symptoms — Anxiety or distress due to recurrent infections or discomfort.
- Typical characteristics — Often recurs despite treatment, especially in individuals with deep hair follicles or a family history of the disease.
When to see a doctor for pilonidal disease
Plan a visit with a dermatologist or a general surgeon if you have persistent pain, swelling, or recurrent abscesses in the buttock area.
Visit an emergency room if your child develops signs of a severe infection. If they have a high fever, severe pain, or inability to sit comfortably, seek care right away.
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How Do You Diagnose Pilonidal Disease?
Doctors, including dermatologists and general surgeons, typically diagnose pilonidal disease with a physical exam and review of symptoms. They may use imaging studies to evaluate the extent of the disease.
They'll look for signs of cysts, abscesses, or sinus tracts in the buttock area. They may also inquire about pain and swelling. Your child's doctor may look for signs of infection, such as drainage or inflammation.
They may ask detailed questions about your child's health history. They'll ask if this has happened to them before or to any other members of your family.
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How Do You Treat Pilonidal Disease?
Prevention for pilonidal disease includes lifestyle changes for prevention, hair removal, and surgery.
For an acute infection, your child may need treatment with antibiotics and surgery to clean and remove the cyst. Once the initial infection calms down, a surgeon should evaluate the region. They'll look for the small pilonidal pits or tracts that can cause persistent disease or recurrence.
Lifestyle changes for prevention
Prevention is key in treatment. This includes good hygiene. Keep the gluteal crease (buttock crack) clean and dry with careful scrubbing. Cleaning the area well with a clean cloth will help prevent debris, lint, and hair from being trapped there. Avoiding long periods of sitting can also help.
Hair removal
Hair removal from the gluteal cheeks and lower back can help prevent hair from becoming trapped in the crease. You can remove the hair with topical solutions (Nair), clippers, or laser hair removal.
Laser hair removal is the only option that gets rid of the hair in the long term. Studies have shown a lower recurrence rate of pilonidal disease after laser hair removal than no hair removal, razor, or cream depilation.
Laser hair removal is offered in our clinic to help treat pilonidal disease. It has been demonstrated to be safe and effective in teenagers and is an integral part of the care for this chronic debilitating disease.
The Pediatric Pilonidal Clinical Program can do laser hair removal for pilonidal disease. They work with our pediatric surgical practice at UPMC Children's Hospital of Pittsburgh for any surgical treatment needed. The clinic streamlines the patient's management.
Our approach leads to effective and efficient hair removal. People need an average of four to seven treatments, each approximately six to eight weeks apart.
Surgery
Surgery ranges from minimally invasive procedures like pit picking (Gips procedure) to more extensive surgeries for chronic or severe cases. Your child's surgeon can help discuss and decide which may be best for your child.
If your child has mild pilonidal pits, a pit picking procedure can be done in the clinic. This procedure is usually performed with numbing medicine. It will remove the pilonidal pits that connect to the deeper pilonidal cyst.
They will also remove hair and residual inflammatory tissue from the cysts. The skin will heal and prevent further debris from becoming stuck or infected in the cyst.
If the region has very large pits or extensive disease, the surgeon may do the surgery in the operating room under anesthesia. If a patient requires surgery, they may apply phenol to the cyst. Phenol helps to dissolve debris and rid the cavity of inflammatory tissue.
Numerous pits or diseases that do not respond to pit picking may require more extensive surgery. These flap-type procedures, such as the cleft lift, remove more irritated tissue. Surgeons attempt to make the gluteal crease flat.
Sometimes, the area requires extensive wound care to assist with the healing of the region. It may need frequent dressing changes or wound vacuum assist devices.
What happens during surgery for pilonidal disease?
During your child's clinic visit for pilonidal disease, a team of experts will review their case and examine them. You and your child will meet with our provider, who will review their particular history. They will then examine your child.
If your child has had a recent infection, they won't do a procedure that day, as the area must be allowed to heal. If the area is infected, it may need to be treated with antibiotics or an incision and drainage of any abscess.
Drainage is when the physician lances the infected area to release the pressure and drain the pus. Warm compresses and soaking baths may also help to drain the infection.
We will educate you and your child on the nature of pilonidal disease, routine care at home, and their treatment and healing plan. If the area has not had a recent infection, your child may undergo their initial treatment that day with a pit picking.
Is surgery right for me?
When deciding on the best treatment for pilonidal disease, consider:
- Effectiveness — Choose a treatment method with a high success rate in getting rid of cysts and stopping them from coming back.
- Recovery time — Opt for treatments with shorter recovery periods and minimal post-operative discomfort.
- Long-term outcomes — Assess which treatment option offers the best long-term outcomes, including reduced risk of recurrence and complications.
- Personalized approach — Consult with health care providers to tailor the treatment plan based on individual factors such as age, health status, and severity of the condition.
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Why Choose UPMC for Pilonidal Disease Care?
UPMC Children's Hospital of Pittsburgh has a team of pediatric general and thoracic surgeons. They are experts in treating pilonidal disease. They have years of experience with this relatively common but stubborn problem. Our team also uses state-of-the-art treatments and minimally invasive approaches where possible to address this problem.
We understand the discomfort this disease can cause and are dedicated to helping patients manage their conditions. We are committed to providing care tailored to your child, including various medical and surgical options.
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Last reviewed by a UPMC medical professional on 2024-10-11.
