pilonidal

Pilonidal disease is a benign, chronic condition that occurs most commonly in the sacrococcygeal region, presenting as a cyst, abscess, or sinus tract containing hair and skin debris. The term derives from the Latin “pilus” (hair) and “nidus” (nest), reflecting the typical hair‑filled lesion. It usually affects adolescents and young adults, with a peak incidence between ages 15 and 30, and is more prevalent in males than females, particularly in individuals with a sedentary lifestyle, excessive body hair, obesity, or deep natal cleft.

The exact pathogenesis remains debated, but the prevailing theory is that hair shafts penetrate the skin of the intergluteal cleft, triggering a foreign‑body inflammatory reaction that leads to granulation tissue formation and sinus development. Repeated mechanical irritation, pressure, and moisture may exacerbate the process. Clinically, patients often report pain, swelling, and a palpable midline nodule that may become tender, fluctuate, or discharge serous or purulent material. Acute pilonidal abscesses present with rapid onset of pain, erythema, and fever, whereas chronic disease is characterized by intermittent discharge and recurrent sinus formation.

Diagnosis is primarily clinical, based on inspection and palpation. Imaging, such as ultrasound or MRI, is reserved for atypical presentations or to delineate complex tracts. Treatment varies with disease severity. Acute abscesses are managed initially with incision and drainage, followed by antibiotics if infection is evident. Definitive care for chronic or recurrent disease often involves surgical excision of the sinus tract—options range from simple excision with primary closure to flap techniques designed to flatten the natal cleft. Minimally invasive methods, including phenol cauterization or laser ablation, are increasingly used.

Recurrence rates depend on surgical technique and postoperative care, with rates reported between 5 % and 30 %. Preventive measures focus on hygiene, hair removal (shaving, depilatory creams, or laser), and maintaining a reduced pressure environment in the intergluteal cleft through weight management and avoidance of prolonged sitting. Prognosis after appropriate treatment is generally favorable, with most patients experiencing lasting relief.