Highlights & Basics
- Pilonidal disease is a chronic, suppurative condition most commonly involving the natal cleft that typically affects young men.
- It is an acquired disease in which loose hairs trapped within the natal cleft penetrate the skin leading to a granulomatous foreign body reaction. As a result, midline pits within the natal cleft and chronic sinus tracts may develop.
- Pilonidal disease may be asymptomatic or present with an acute abscess or a chronic cyst and/or sinus with persistent drainage.
- Asymptomatic disease does not mandate treatment. An acute pilonidal abscess should undergo drainage, ideally unroofing and curettage. Conservative (nonsurgical) treatments for chronic pilonidal disease have yielded mixed reports of success. Currently, there is no consensus on the optimal surgical treatment and many different techniques are available. Complications of tissue healing and recurrence are frequent.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Gil LA, Deans KJ, Minneci PC. Management of pilonidal disease: a review. JAMA Surg. 2023 Aug 1;158(8):875-83.[Abstract]
Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons' clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019 Feb;62(2):146-57.[Full Text]
Segre D, Pozzo M, Perinotti R, et al. The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol. 2015 Oct;19(10):607-13.[Abstract]
1. Luedi MM, Schober P, Stauffer VK, et al. Gender-specific prevalence of pilonidal sinus disease over time: a systematic review and meta-analysis. ANZ J Surg. 2021 Jul;91(7-8):1582-7.[Abstract][Full Text]
2. Sondenaa K, Andersen E, Nesvik I, et al. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10:39-42.[Abstract]
3. Akinci OF, Bozer M, Uzunkoy A, et al. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg. 1999 Apr;165(4):339-42.[Abstract]
4. Gil LA, Deans KJ, Minneci PC. Management of pilonidal disease: a review. JAMA Surg. 2023 Aug 1;158(8):875-83.[Abstract]
5. Shareef SH, Hawrami TA, Salih AM, et al. Intermammary pilonidal sinus: the first case series. Int J Surg Case Rep. 2017;41:265-8.[Abstract][Full Text]
6. Patel MR, Bassini L, Nashad R, et al. Barber's interdigital pilonidal sinus of the hand: a foreign body hair granuloma. J Hand Surg Am. 1990 Jul;15(4):652-5.[Abstract]
7. Mohanna PN, Al-Sam SZ, Flemming AF. Subungual pilonidal sinus of the hand in a dog groomer. Br J Plast Surg. 2001 Mar;54(2):176-8.[Abstract][Full Text]
8. Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery. 1980 May;87(5):567-72.[Abstract]
9. Kraft CT, Khansa I, Janis JE. Practical management of pilonidal disease. Plast Reconstr Surg Glob Open. 2020 Dec 22;8(12):e3270.[Abstract][Full Text]
10. Karydakis GE. New approach to the problem of pilonidal sinus. Lancet. 1973 Dec 22;2(7843):1414-5.
11. Hull TL, Wu J. Pilonidal disease. Surg Clin North Am. 2002 Dec;82(6):1169-85.[Abstract]
12. Harlak A, Mentes O, Kilic S, et al. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors. Clinics (Sao Paulo). 2010 Feb;65(2):125-31.[Abstract][Full Text]
13. Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons' clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019 Feb;62(2):146-57.[Full Text]
14. Halleran DR, Lopez JJ, Lawrence AE, et al. Recurrence of pilonidal disease: our best is not good enough. J Surg Res. 2018 Dec;232:430-6.[Abstract]
15. Vahedian J, Nabavizadeh F, Nakhaee N, et al. Comparison between drainage and curettage in the treatment of acute pilonidal abscess. Saudi Med J. 2005 Apr;26(4):553-5.[Abstract]
16. Mavros MN, Mitsikostas PK, Alexiou VG, et al. Antimicrobials as an adjunct to pilonidal disease surgery: a systematic review of the literature. Eur J Clin Microbiol Infect Dis. 2013 Jul;32(7):851-8.[Abstract]
17. Segre D, Pozzo M, Perinotti R, et al. The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol. 2015 Oct;19(10):607-13.[Abstract]
18. Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804.[Abstract][Full Text]
19. Pronk AA, Eppink L, Smakman N, et al. The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol. 2018 Jan;22(1):7-14.[Abstract]
20. Al-Khamis A, McCallum I, King PM, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2010;(1):CD006213.[Abstract][Full Text]
21. Win M, Went TR, Ruo SW, et al. A systematic review of fibrin glue as an ideal treatment for the pilonidal disease. Cureus. 2021 Aug 2;13(8):e16831.[Abstract][Full Text]
22. Lund J, Tou S, Doleman B, et al. Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev. 2017 Jan 13;1:CD011923.[Abstract]
