Dr Naseem Mirbagheri:
Pilonidal disease is a skin disorder of the natal cleft, that’s the dimple or crease in between the buttock cheeks, and it tends to affect young men mostly. It usually starts with an abscess, which is often drained under general anaesthesia; and after the abscess goes away, people are left with a pilonidal sinus.
Now, in many people it causes no symptoms, but you can end up with a lump at the top of your buttocks which can become inflamed and painful, especially when you’re sitting, and this can also discharge. A pilonidal sinus is more commonly seen in people with a lot of body hair, in men more than women, and those with a family history. Being overweight, smoking, a sedentary lifestyle, and prolonged sitting or driving can also put you at risk.
The way the problem is thought to arise is that a hair gets trapped and burrows under the skin causing inflammation and infection, resulting in an abscess. You can often see the tiny openings between the buttocks where the hair has burrowed in.
The sinus is usually describes a blind ending tunnel that leads to a cavity from the small hole or the pit on the skin’s surface. In others, chronic pilonidal disease occurs, whereby they experience recurrent infection and discharge from the top of the buttocks.
The surgical treatment of pilonidal sinus includes drainage of the abscess, and in patients with chronic diseases, the goal is to remove all the hair in the cavity, clean the track, and get rid of the pits.
In some people, a more involved surgery may be required, and in this procedure a flap is created to make the natal cleft more shallow. The flap creation is a relatively major operation, and it’s reserved for patients with severe disease. In this scenario, all the diseased tissue is removed, and a layer of healthy buttock tissue is mobilised and brought across to cover it. This is sometimes called a Karydakis procedure, and the success rate of this procedure is variable. With this procedure you’re likely to require a few weeks off work.
Other techniques include excising the diseased skin and either leaving it open to heal, or closing it. It is important to appreciate that any wound in the natal cleft heals poorly, and you may be left with a wound that might require dressing for months before it heals completely. Due to the poor healing capacity of the natal cleft tissue, less invasive key-hole procedures are now available such as endoscopic removal of hair from the pilonidal cavity, cleaning of the cavity and obliteration of the sinus by burning the inner lining. This results in faster return to work and a smaller wound, with results probably similar to other procedures.
Some surgeons might even offer you fibre and glue insertion into the sinus tract. Unfortunately there’s not much you can do to help reduce the recurrence rate after you have this disease. Shaving the hair around the buttocks or using laser hair removal have conflicting evidence and may make the condition worse. If you suspect that you have a pilonidal disease please talk to your doctor because you will probably need a referral to an appropriate specialist for management. The good news is that this disorder is rare in the elderly, as the hair gets softer and the depth of natal cleft becomes less.