11 March 2019 It initially involves an acute skin abscess . A hair-filled pouch or pit (pilonidal sinus) then forms. There are repeated episodes of swelling, pain and discharge as a result of the subsequent inflammation and infection and the formation of fistulas that drain onto the skin’s surface. In rare cases, pilonidal disease also affects other parts of the body in addition to the crease between the buttocks. What are the main causes of pilonidal disease? There are two possible causes of pilonidal disease: Penetration and growth of hairs into the skin resulting in an inflammatory reaction; Irritation of or trauma to the hair follicles, which become blocked and infected and form an abscess. Both cases can result from rubbing or trauma to the area , such as: Wearing tight clothes; Exercise such as cycling or horse-riding, especially when it is hot. Who can get pilonidal disease and what are the risk factors? Pilonidal disease is diagnosed mostly between puberty and 40-50 . It is more common in men , which may be because they have more hairs in the region. Hairs are one of the most important risk factors for developing the disease. Other risk factors for pilonidal disease include: A sedentary lifestyle; Occupations that require remaining seated for a long time; Activities that may cause trauma to the region; Obesity; A previous lesion or irritation in the area; Poor hygiene; Excessive sweating. What are the symptoms of pilonidal disease? The symptoms include a lump in the crease between the buttocks, which may vary from a small pimple to a large, painful mass. This area often produces a fluid, which may be clear, cloudy or bloody. In the event of an infection, the area is red and painful and discharges foul-smelling pus . There may also be systemic symptoms, such as: Fever; Malaise; Nausea. How is pilonidal disease diagnosed? The diagnosis of pilonidal disease is based on: Clinical history; Symptoms; Examination of the patient. As a rule, no lab tests are necessary. How is pilonidal disease treated? Treatment of the disease depends on what phase it is in. An acute abscess in which the area is swollen and painful and discharges pus tends to clear up on its own. Pain and swelling can be reduced with: Medication; Cutting the abscess open and draining the pus under local or general anaesthetic. Surgery is necessary in most patients with fistulas, a pilonidal sinus and recurring episodes of pain, swelling and pus discharge. More or less complex approaches vary and range from opening and cleaning fistulas, leaving an open wound , to excision and possible closure with skin grafts. If the wound is left open (healing by secondary intention), frequent dressing changes will control oozing and promote healing from the inside out. In this case, the recovery period is usually longer , but the probability of a permanent cure is greater. In the event of primary intention healing or use of skin grafts, added care will be necessary to keep the wound clean and dry until it has healed completely. Special care must be taken due to the wound’s proximity to the anus, which raises the risk of infection. In both cases, after the wound has completely healed, the skin around the scar must be kept clean and hairless. Gastroenterologists and general surgeons can help treat this disease. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
