Pilonidal disease: Symptoms, diagnosis, and effective treatment

Pilonidal disease is a common medical condition affecting the area near the tailbone that can discomfort, pain, and in some cases, lead to serious infections. This article provides a comprehensive understanding of pilonidal disease, addressing its symptoms, diagnosis, treatment options, and prevention measures.

What is pilonidal disease?

Pilonidal disease is a chronic skin condition that develops in the cleft between the buttocks, near the tailbone. Early signs include a small dimple or opening in the skin, which may become infected. Over time, this can develop into a painful cyst or abscess.

In addition, common symptoms also include redness, swelling, tenderness, and drainage of pus or blood from the affected area. In severe cases, the infection can cause fever or systemic discomfort.

Pilonidal disease is most common in young adults, particularly males. While the exact cause is unclear, the condition typically develops when hair punctures the skin and becomes embedded, causing inflammation and infection.

How is pilonidal disease diagnosed and treated?

Diagnosing pilonidal disease involves a physical examination, where your surgeon will assess the affected area for signs of infection, such as swelling, redness, or drainage. In most cases, no additional diagnostic tests are necessary. However, imaging studies such as ultrasound or MRI may be ordered if the extent of the disease is unclear or deeper infections are suspected.

Treatment also depends on the stage and severity of the condition. For mild cases without cysts or abscesses, conservative management alone may be sufficient, including cleaning the area thoroughly, removing excess hairs, and applying warm compresses. Topic or oral antibiotics may be prescribed if an infection is present.

What surgical options are available?

Surgery is the most effective way to treat recurrent or advanced cases of pilonidal disease. Various options are available, and the choice of procedure is tailored to the patient’s needs and the complexity of their condition.

Incision and drainage

For cases involving cysts or abscesses, incision and drainage is commonly performed. This procedure involves opening the abscess to remove pus and debris and relieve pressure. While effective for immediate relief, incision and drainage doesn’t address the underlying sinus tracts, making recurrence possible.

Excision

For advanced or recurrent cases, excision is usually necessary. This procedure involves removing the entire sinus tracts and can involve either:

• Excision with secondary healing: This approach involves removing the entire sinus tracts and leaving the wound open to heal naturally. Healing takes longer, but the risk of recurrence is less compared to primary closure.
• Excision with primary closure: This approach involves removing the entire sinus tracts and closing the wound with stitches. Recovery is faster, but the risk of infection is slightly higher compared to secondary healing.

Regardless of the procedure, postoperative care is critical for successful pilonidal disease outcomes. This includes regular wound cleaning, follow-up appointments, and adherence to your surgeon’s recommendations to support healing.

Are there ways to prevent pilonidal disease?

Pilonidal disease can’t always be prevented, but certain measures can help reduce the risk of developing it or experiencing a recurrence:

• Good hygiene: Washing the area by the tailbone daily and keeping it dry can help prevent irritation and the buildup of bacteria and debris. Additionally, maintaining good hygiene also helps prevent excessive sweating, which is a risk factor for pilonidal disease.
• Hair removal: Removing excess hair - whether through shaving, waving, or laser treatment - can help prevent hair from becoming embedded in the skin.
• Loose-fitting clothing: Wearing loose-fitting clothes minimises friction and pressure in the skin, helping to reduce irritation and prevent the formation of cysts.
• Regular breaks: For people who sit for extended periods or who have sedentary jobs, taking regular breaks to stand and move around can help relieve pressure on the tailbone and reduce the risk of developing a cyst.

It’s important to know that even with these precautions, some people will remain predisposed to pilonidal disease due to genetic factors or other underlying conditions. In such cases, early detection and prompt treatment are key to managing the condition effectively.