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Pilonidal disease

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What is a pilonidal sinus?

A pilonidal sinus is an inflamed track or tunnel which leads to a cavity under the skin, at the lower end of the back or natal cleft.  Pilonidal disease is thought to occur when an abscess develops in the base of a hair folicle.  Instead of draining onto the surface , like spot, it bursts sideways into the subcutaneous tissues.  The hair then grow into the area and sets up a chronic inflammatory process. If the tract and/or cavity become infected an abscessdevelops.

Who gets it?

It usually affects young men, especially hairy ones. It is thought to be more common in those who drive a lot.

How will I know if I’ve got one?

Commonly patients have one or more small holes in the skin at the lower end of their backs, within the natal cleft.  They can occassionaly leak pus.  Some patients may present with a recurrent pilonidal sinus following a previous attempt at curing the condition.  In some people they can be asymptomatic.  Sometimes a pilonidal sinus may become inflamed and develop into an abscess.

How will I know if I’ve got an abscess?

The overlying and surrounding skin will become warm, red, swollen and very painful.  This usually develops over 1-2 days.  In some cases, prompt antibiotics eg Augmentin may stop an abscess developing.  Pus needs surgical drainage.   If surgery becomes necessary the area will be loosley packed with gauze.  This will require changing by a District Nurse and may take 2-3 months to heal.  To prevent the abscess recurring, the skin is not closed with stitches.  In the end, some patients may be left with a pilonidal sinus that requires further treatment.  This occurs in approximately 50-60% of cases.

Is it dangerous?

Pilonidal disease is not dangerous.  It is however, uncomfortable and a nuisance.

Do I need any tests or special investigations?


Is there anything else it could be?

There are a couple of conditions that can look like pilonidal disease.  These include fistula-in-ano where a track runs from the anus to the lower end of the back,and hidradenitis suppurativa where the infection develops in the sweat glands. Neither of these is dangerous, but both may require surgical drainage.

What procedures are available to treat pilonidal disease?

Pilonidal disease can be very difficult to treat.  There are many operations that are used to treat the condition. 

These broadly divide into procedures where the skin and track are excised and the wound left open, to be packed by a District Nurse. 

In other cases the skin is closed primarily with sutures.  The advantage of closing the skin is that the wound heals faster.  This may however not be technically possible, if all the pilonidal disease is to be excised. 

The exact procedure is tailored to the individual patient and should be discussed with your surgeon.  In cases where the pilonidal sinus has recurred, more complex plastic surgical procedures may be recommended.

Are there any complications of these procedures?

Complications can occur with any sort of surgical procedure.  The most common here include infection and bllding and haematoma (blood clot) formation.  These depend on which surgical approach has been used, being common when the skin is closed as opposed to left open and packed.  In cases wher an infection develops, the wound will be opened up and allowed to heal slowly.

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