Table of contents
Expand All Topics
Pilonidal disease
Background
Overview
Definition
PD is a chronic inflammatory condition that typically occurs in the intergluteal region, characterized by the presence of sinus tracts and often associated with abscess formation.
1
Pathophysiology
The exact pathogenesis of PD is unclear; however, the proposed mechanism includes the formation of midline pits in the sacrococcygeal region due to skin stretching. The debris in the pits causes subcutaneous inflammation and infection, resulting in chronic pilonidal draining tracts and acute abscess formation.
2
3
Epidemiology
There are an estimated 70,000 cases of PD annually in the US, with most occurring in adolescents and young adults. The incidence of PD in Norway is estimated at 26 per 100,000 person-years.
2
4
Risk factors
Risk factors for PD include male gender, obesity, occupations requiring prolonged sitting or continuous bouncing in a seated position, such as truck driving, deep natal clefts, excessive body hair, poor body hygiene, and excessive sweating. Stiffness of body hair and greater time spent seated per day are the most predictive risk factors.
5
Disease course
The clinical course of PD is often characterized by recurrent episodes of inflammation, abscess formation, and sinus tract development. Symptoms typically include pain, swelling, and purulent discharge from the affected area. Malignant transformation may occur with chronic complex fistulas and poor healing.
6
7
Prognosis and risk of recurrence
About half of the cases recur after the first intervention, and 10-30% after subsequent interventions.
6
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of pilonidal disease are prepared by our editorial team based on guidelines from the European Society of Coloproctology (ESCP 2024), the American Society of Colon and Rectal Surgeons (ASCRS 2019), the German National Guideline (GNG 2016), and the Italian Society of Colorectal Surgery (SICCR 2015).
1
2
3
4
5
6
7
8
9
10
Classification and risk stratification
Diagnostic investigations
History and physical examination: as per ESCP 2024 guidelines, elicit a succinct history including onset, risk factors, and previous management of PD.
E
Show 3 more
More topics in this section
Diagnostic imaging
Laboratory tests
Diagnostic procedures
Medical management
General principles
As per ESCP 2024 guidelines:
Consider managing modifiable risk factors (such as smoking cessation) before offering definitive management for PD.
E
Consider managing adolescent patients according to adult practice guidelines.
C
More topics in this section
Antibiotic therapy
Nonpharmacologic interventions
Therapeutic procedures
Phenol and fibrin glue injection
As per ESCP 2024 guidelines:
Consider offering treatment with phenol in patients undergoing PD surgery.
C
Consider offering treatment with fibrin glue in patients undergoing PD surgery.
C
More topics in this section
Platelet-rich plasma
Perioperative care
Preoperative hair removal: as per ESCP 2024 guidelines, insufficient evidence to support that hair removal before surgery affects outcome.
I
More topics in this section
Anesthesia
Perioperative antibiotic prophylaxis
Intraoperative ultrasound
Surgical interventions
General principles
As per ESCP 2024 guidelines:
Consider offering definitive surgical treatment in patients with symptomatic PD.
E
Do not offer prophylactic intervention in patients with asymptomatic PD.
D
More topics in this section
Incision and drainage
Minimally invasive surgery
Excision and repair