How I Manage Pilonidal Disease

Abstract

In brief: Pilonidal disease is a typical foreign-body reaction. Free hair migrates into the intergluteal fold in the sacral coccygeal area and perforates the skin, which sets up a point of entry for further hair buildup. The hair ball causes no reaction or symptoms until it is invaded by pathogens. Abscess, draining sinuses, and cellulitis then develop. Treatment is an outpatient procedure and is essentially the same whether there is a cyst, sinus granuloma, or abscess. It may be necessary to infiltrate over the area and allow purulent sanguineous material to drain out before irrigating the area. A small foreign-body snare is used to extract the hair. Recurrences can be prevented by emphasizing the importance of shaving and local cleansing.