Pilonidal Disease

What are the different types of Pilonidal Disease?

Pilonidal cysts look like a small dimple or, in severe cases, they can be as large as a golf ball. If they go untreated, pilonidal disease typically gets worse. Patients may experience the following:

• Pilonidal pit or sinus, a small hole in the skin that connects to a pilonidal cyst (a nest of ingrown hairs). Patients may have multiple pilonidal sinuses but only one cyst.
• Pilonidal abscess, where, if pilonidal sinuses and underlying cyst go untreated, more hair and particles can move into the affected area and cause infections. Abscesses can be very painful and require intensive treatment. Many kids experience multiple abscesses with flare ups over several months.

What are the signs and symptoms of Pilonidal Disease?

• Tailbone pain when sitting or standing
• Small dimple or mass between the buttocks
• Red, irritated skin
• Swelling
• Pus or blood

How is Pilonidal Disease diagnosed?

Doctors can diagnose pilonidal disease with a physical exam. They’ll be able to see the infection with the naked eye, assess how severe it is, and determine the best treatment for your child. Ultrasounds or other images are usually not needed.

What are the causes of Pilonidal Disease?

Hormone changes in teenagers and young adults, as well as individual anatomy, can cause hair follicles to grow into the skin, leading to pilonidal disease. Things that irritate this area – such as tight clothing, long periods of sitting or activities like horseback riding or bike riding – can contribute to the disease.

How is Pilonidal Disease treated?

Our team uses both surgical and non-operative approaches to treat pilonidal disease. For many patients, the disease may come back after initial treatment, and we provide treatment over several weeks to months. We will evaluate your child’s condition and pick the best treatment option for them. Treatments include:

Hair removal and hygiene

For most children, we’ll start by treating pilonidal disease by soaking the area to reduce swelling and infection. Some children may also need oral antibiotics to treat the infection.

The mainstay of successfully treating pilonidal disease and keeping it from coming back is hair removal. This can be achieved through shaving, although it is important to shave the hair along the edges of the wound which is often challenging. Laser hair removal or chemical hair removal can be better options. Your physician or wound care nurse can provide for information about hair removal options.

Draining the abscess

If your child has a pilonidal abscess, our team may need to drain it to get rid of the infection, helping it heal faster and relieve pain. Doctors will explain this process to you and your child, and help kids understand what to expect. To drain the abscess, our team will:

• Use local anesthesia (anesthesia just in one spot, while your child is still awake) to numb the area.
• Make a small cut so fluid can drain from the abscess.
• Cover the wound with a dressing to allow it to continue to drain
• Teach parents and patients about cleaning and care after the procedure.

Surgery

At Children’s Health, we do everything we can to treat pilonidal disease without surgery. However, surgery can be the best option for patients who have severe pilonidal disease or for kids whose disease keeps coming back.

At Children’s Health, we have male and female surgeons — and many kids feel more comfortable with a doctor of their gender. Most kids go home the same day that they undergo one of these simple procedures:

• Removing the pits under anesthesia. Doctors make small incisions to remove all pits and underlying trapped hairs. They leave the wound open to help it heal. This is the least invasive surgery option.
• Removing the cyst (typically a larger area of tissue than just the pit) and covering the area with dressings that you will learn to change at home over several weeks.