Everything You Need to Know About Pilonidal Disease

Pilonidal disease is a long-term, often relapsing skin infection that develops in the area just above the buttock crease (gluteal cleft). It happens when the body reacts to hair embedded beneath the skin. Trapped hair causes the body to react the same as it would to a foreign body. A cyst or abscess may develop, causing swelling and pain. Pus may drain from the abscess. 

Board-certified colorectal surgeon Lisa A. Perryman, MD, and her team at Colorado Colon & Rectal Specialists in Parker, Colorado, are dedicated to ensuring top-quality patient care in the diagnosis and management of diseases and disorders of the colon. 

Dr. Perryman offers numerous treatment options for pilonidal disease, following a comprehensive evaluation. Dr. Perryman takes care to distinguish pilonidal disease from alternative diagnoses that may have a similar clinical presentation to ensure an accurate diagnosis.

Here’s what you need to know if you’re diagnosed with or suspect you have pilonidal disease.

What is pilonidal disease?

In pilonidal disease, loose hairs trapped beneath the skin give rise to recurring skin infections in the buttock crease region. Most commonly this happens between adolescence and age 40. Men are more likely to get pilonidal disease than women, and it more often occurs in people with thick, stiff body hair. 

Other risk factors include:

• Family history
• Course or curly hair
• Deep buttock crease
• Extended time sitting
• Being overweight
• Past injury to the area

Symptoms vary widely from person to person. Some people have no symptoms at all, while others develop small cysts, and still others may develop large, painful abscesses that persistently drain pus. 

Most people with pilonidal disease will develop at least one abscess that either resolves on its own or with medical intervention. Some people will develop chronic or recurrent abscesses. These can cause a significant amount of pain and swelling, as well as drainage.

Managing pilonidal disease 

Abscesses that develop suddenly are typically drained to reduce inflammation and pain. This is usually done in-office with local anesthesia. Chronic abscesses generally require surgical treatment as they can create a small tunnel below the skin that connects to the surface. This tunnel is called the sinus. After the abscess resolves, surgery to remove the sinus can be completed, usually in an outpatient setting.

During surgery, Dr. Perryman visualizes the sinus tract to see how deep it is and where it leads, then removes the diseased tissue. A flap closure can then be performed. 

You can resume your regular daily activities after surgery. Dr. Perryman will provide post-surgery care instructions.  

Even after the abscess is removed, some patients may develop a new one. In some cases, chronic infection can cause more complex sinus disease. In these cases, surgery is often required to eliminate the disease so that the skin can heal.

If you’re dealing with pilonidal disease, we can help. Following treatment, hair removal strategies such as waxing and shaving can keep pilonidal disease from coming back. Laser hair removal significantly reduces the chance of recurrence. To learn more about how we manage pilonidal disease, give our team a call at 303-840-8822 or book online to schedule an appointment with Dr. Perryman.