Pilonidal disease, also known as pilonidal sinus or cyst, is a common condition that affects the area at the top of the buttocks near the tailbone. It occurs when a hair follicle becomes blocked and infected, forming a cyst or sinus tract. Pilonidal disease is common in young adults, particularly in men. Other risk factors include a family history of the condition, obesity, a sedentary lifestyle, and excessive body hair.
The initial stage of pilonidal disease often involves the formation of a small cyst or abscess that can cause pain, swelling, and redness in the affected area. If left untreated or if the condition worsens, the cyst may become infected, developing a pilonidal sinus. The exact cause of pilonidal disease is not fully understood, but it is believed to be a combination of factors.
One contributing factor is the presence of hairs that can penetrate the skin and cause irritation. Friction or prolonged pressure on the affected area, such as sitting for long periods, can also play a role.
Epidemiology
Pilonidal disease is a relatively common condition that primarily affects young adults, particularly males, although it can occur in individuals of any age or gender. Pilonidal disease is estimated to have an annual incidence of approximately 26 cases per 100,000 individuals. The incidence may be higher in certain populations, such as those with a higher prevalence of risk factors.
The pilonidal disease commonly affects individuals between the ages of 15 and 30, with the highest incidence occurring in the second and third decades of life. Males are more commonly affected than females, with a male-to-female ratio ranging from 2:1 to 5:1. Pilonidal disease occurs worldwide. However, there may be some variation in its prevalence among different countries and ethnic groups.
It has been reported to be more prevalent in certain regions, including North America, Europe, and the Middle East. Certain occupations that involve prolonged sitting or friction in the sacrococcygeal region, such as truck drivers, may have a higher incidence of pilonidal disease.
Anatomy
Pathophysiology
The exact pathophysiology of pilonidal disease is not fully understood, but it is believed to be multifactorial and involves a combination of anatomical, mechanical, and microbial factors. The primary contributing factor is the presence of hair follicles in the natal cleft. When hair penetrates the skin, it can irritate and trigger an inflammatory response. Certain anatomical factors, such as a deep natal cleft or excessive hair growth, can increase the likelihood of hair penetration and subsequent inflammation.
The mechanical aspect of the pilonidal disease involves friction and pressure on the affected area. Activities that involve prolonged sitting or repetitive trauma, such as cycling or truck driving, can exacerbate the condition. These mechanical forces can lead to hair follicle damage and subsequent inflammation. Microbial factors also play a role in pilonidal disease.
The area between the buttocks is prone to excessive sweating, which creates a warm and moist environment. This environment promotes the growth of bacteria and fungi, leading to infection and further inflammation. The combination of hair penetration, inflammation, mechanical factors, and microbial colonization can form a pilonidal sinus or abscess. The sinus or abscess is usually accompanied by pain, swelling, redness, and drainage of pus or blood.
Etiology
The etiology of pilonidal disease, also known as pilonidal cyst or pilonidal sinus, is not fully understood. However, several factors have been identified that contribute to its development. The primary etiological factors of pilonidal disease include:
Congenital Factors: Some studies suggest that certain congenital factors may predispose individuals to develop pilonidal disease. These factors include a deep natal cleft, excess hair growth, and abnormal skin characteristics. These anatomical variations can contribute to hair entrapment and subsequent inflammation.
Hormonal Factors: Hormonal changes may play a role in the development of pilonidal disease. It is observed that the condition is more common in young adults, particularly males. Hormonal changes during puberty and increased hair growth during this time may contribute to the development of pilonidal disease.
Infection: Bacterial or fungal infection in the natal cleft area may contribute to the progression and exacerbation of pilonidal disease. The warm and moist environment between the buttocks is conducive to microbial growth. Infections can lead to increased inflammation, abscess formation, and the development of chronic or recurrent pilonidal disease.
Trauma or Friction: Repeated trauma or friction in the natal cleft area can contribute to the development of pilonidal disease. Activities that involve prolonged sitting, such as sitting on hard surfaces or long-distance driving, can increase the risk. The friction and pressure can cause hair to penetrate the skin and initiate the inflammatory process.
Genetics
Prognostic Factors
Pilonidal disease is generally considered a benign condition, although there have been rare reports of malignant transformation or development of skin cancer.
While the pilonidal disease can have a relatively high recurrence rate and may necessitate multiple procedures, the prognosis overall is favorable when appropriate lifestyle modifications are implemented, and an accurate diagnosis is made.
Clinical History
Clinical History
Patients often experience pain and discomfort in the sacrococcygeal region above the tailbone. The pain may range from mild to severe and can be aggravated by sitting, standing, or movement. The affected area may exhibit swelling and redness. The skin around the pilonidal sinus or abscess can appear inflamed and tender to the touch.
Hair might be visible in the sinus or abscess, as the condition typically involves hair follicle irritation and penetration. Pilonidal disease tends to recur, with symptoms flaring up periodically or persistently. Recurrence may result in the formation of multiple sinus tracts or abscesses.
Physical Examination
Physical Examination
The presence of one or more sinus tracts or pits is a characteristic finding of pilonidal disease. These are small openings or depressions in the skin, typically located in the natal cleft (the area between the buttocks, near the tailbone). The sinus tracts may be visible as small holes or may be covered with hair. In some cases, pilonidal disease can progress to an abscess, a localized pus collection. Abscesses may appear as swollen, tender, and red areas of the skin.
Pilonidal disease can cause intermittent or chronic fluid drainage from the sinus tracts or abscesses. The drainage can vary in consistency and may include pus, blood, or clear fluid. The affected area may exhibit signs of inflammation, such as redness and increased warmth. Inflamed skin around the sinus tracts or abscesses can be tender to the touch.
Pilonidal disease is often associated with hair within the sinus tracts or pits. This can be observed upon examination, mainly if the sinus tracts are open. In cases of chronic or recurrent pilonidal disease, scarring, and fibrosis may develop. These can be observed as thickened or hardened areas of the skin in the affected region.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Anal Fistula
Epidural Abscess
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Pilonidal disease is commonly regarded as a condition that necessitates surgical intervention, particularly in cases with acute occurrences accompanied by secondary infection and abscess formation. When infection or abscess is present, it is crucial to address and resolve the infection through incision and drainage procedures before definitive treatment can be pursued.
Various surgical options exist for treating pilonidal cysts and sinuses, and the choice of treatment should be tailored to each patient. It is important to incorporate lifestyle changes and address modifiable risk factors in the treatment plan. Given the role of hair in the development of pilonidal disease, hair removal, and epilation can be utilized as primary or complementary treatments without abscess.
Epilation methods may involve shaving, waxing, laser treatments, or creams. Additionally, fibrin and thrombin products have been employed as primary treatments or adjuncts to surgical techniques for managing pilonidal disease. Despite the availability of nonoperative approaches, the pilonidal disease is primarily considered a surgical condition. For acute cases or abscesses, the primary course of action aligns with standard abscess management, necessitating incision and drainage.
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Pilonidal disease, also known as pilonidal sinus or cyst, is a common condition that affects the area at the top of the buttocks near the tailbone. It occurs when a hair follicle becomes blocked and infected, forming a cyst or sinus tract. Pilonidal disease is common in young adults, particularly in men. Other risk factors include a family history of the condition, obesity, a sedentary lifestyle, and excessive body hair.
The initial stage of pilonidal disease often involves the formation of a small cyst or abscess that can cause pain, swelling, and redness in the affected area. If left untreated or if the condition worsens, the cyst may become infected, developing a pilonidal sinus. The exact cause of pilonidal disease is not fully understood, but it is believed to be a combination of factors.
One contributing factor is the presence of hairs that can penetrate the skin and cause irritation. Friction or prolonged pressure on the affected area, such as sitting for long periods, can also play a role.
Pilonidal disease is a relatively common condition that primarily affects young adults, particularly males, although it can occur in individuals of any age or gender. Pilonidal disease is estimated to have an annual incidence of approximately 26 cases per 100,000 individuals. The incidence may be higher in certain populations, such as those with a higher prevalence of risk factors.
The pilonidal disease commonly affects individuals between the ages of 15 and 30, with the highest incidence occurring in the second and third decades of life. Males are more commonly affected than females, with a male-to-female ratio ranging from 2:1 to 5:1. Pilonidal disease occurs worldwide. However, there may be some variation in its prevalence among different countries and ethnic groups.
It has been reported to be more prevalent in certain regions, including North America, Europe, and the Middle East. Certain occupations that involve prolonged sitting or friction in the sacrococcygeal region, such as truck drivers, may have a higher incidence of pilonidal disease.
The exact pathophysiology of pilonidal disease is not fully understood, but it is believed to be multifactorial and involves a combination of anatomical, mechanical, and microbial factors. The primary contributing factor is the presence of hair follicles in the natal cleft. When hair penetrates the skin, it can irritate and trigger an inflammatory response. Certain anatomical factors, such as a deep natal cleft or excessive hair growth, can increase the likelihood of hair penetration and subsequent inflammation.
The mechanical aspect of the pilonidal disease involves friction and pressure on the affected area. Activities that involve prolonged sitting or repetitive trauma, such as cycling or truck driving, can exacerbate the condition. These mechanical forces can lead to hair follicle damage and subsequent inflammation. Microbial factors also play a role in pilonidal disease.
The area between the buttocks is prone to excessive sweating, which creates a warm and moist environment. This environment promotes the growth of bacteria and fungi, leading to infection and further inflammation. The combination of hair penetration, inflammation, mechanical factors, and microbial colonization can form a pilonidal sinus or abscess. The sinus or abscess is usually accompanied by pain, swelling, redness, and drainage of pus or blood.
The etiology of pilonidal disease, also known as pilonidal cyst or pilonidal sinus, is not fully understood. However, several factors have been identified that contribute to its development. The primary etiological factors of pilonidal disease include:
Congenital Factors: Some studies suggest that certain congenital factors may predispose individuals to develop pilonidal disease. These factors include a deep natal cleft, excess hair growth, and abnormal skin characteristics. These anatomical variations can contribute to hair entrapment and subsequent inflammation.
Hormonal Factors: Hormonal changes may play a role in the development of pilonidal disease. It is observed that the condition is more common in young adults, particularly males. Hormonal changes during puberty and increased hair growth during this time may contribute to the development of pilonidal disease.
Infection: Bacterial or fungal infection in the natal cleft area may contribute to the progression and exacerbation of pilonidal disease. The warm and moist environment between the buttocks is conducive to microbial growth. Infections can lead to increased inflammation, abscess formation, and the development of chronic or recurrent pilonidal disease.
Trauma or Friction: Repeated trauma or friction in the natal cleft area can contribute to the development of pilonidal disease. Activities that involve prolonged sitting, such as sitting on hard surfaces or long-distance driving, can increase the risk. The friction and pressure can cause hair to penetrate the skin and initiate the inflammatory process.
Pilonidal disease is generally considered a benign condition, although there have been rare reports of malignant transformation or development of skin cancer.
While the pilonidal disease can have a relatively high recurrence rate and may necessitate multiple procedures, the prognosis overall is favorable when appropriate lifestyle modifications are implemented, and an accurate diagnosis is made.
Clinical History
Patients often experience pain and discomfort in the sacrococcygeal region above the tailbone. The pain may range from mild to severe and can be aggravated by sitting, standing, or movement. The affected area may exhibit swelling and redness. The skin around the pilonidal sinus or abscess can appear inflamed and tender to the touch.
Hair might be visible in the sinus or abscess, as the condition typically involves hair follicle irritation and penetration. Pilonidal disease tends to recur, with symptoms flaring up periodically or persistently. Recurrence may result in the formation of multiple sinus tracts or abscesses.
Physical Examination
The presence of one or more sinus tracts or pits is a characteristic finding of pilonidal disease. These are small openings or depressions in the skin, typically located in the natal cleft (the area between the buttocks, near the tailbone). The sinus tracts may be visible as small holes or may be covered with hair. In some cases, pilonidal disease can progress to an abscess, a localized pus collection. Abscesses may appear as swollen, tender, and red areas of the skin.
Pilonidal disease can cause intermittent or chronic fluid drainage from the sinus tracts or abscesses. The drainage can vary in consistency and may include pus, blood, or clear fluid. The affected area may exhibit signs of inflammation, such as redness and increased warmth. Inflamed skin around the sinus tracts or abscesses can be tender to the touch.
Pilonidal disease is often associated with hair within the sinus tracts or pits. This can be observed upon examination, mainly if the sinus tracts are open. In cases of chronic or recurrent pilonidal disease, scarring, and fibrosis may develop. These can be observed as thickened or hardened areas of the skin in the affected region.
Differential Diagnoses
Anal Fistula
Epidural Abscess
Pilonidal disease is commonly regarded as a condition that necessitates surgical intervention, particularly in cases with acute occurrences accompanied by secondary infection and abscess formation. When infection or abscess is present, it is crucial to address and resolve the infection through incision and drainage procedures before definitive treatment can be pursued.
Various surgical options exist for treating pilonidal cysts and sinuses, and the choice of treatment should be tailored to each patient. It is important to incorporate lifestyle changes and address modifiable risk factors in the treatment plan. Given the role of hair in the development of pilonidal disease, hair removal, and epilation can be utilized as primary or complementary treatments without abscess.
Epilation methods may involve shaving, waxing, laser treatments, or creams. Additionally, fibrin and thrombin products have been employed as primary treatments or adjuncts to surgical techniques for managing pilonidal disease. Despite the availability of nonoperative approaches, the pilonidal disease is primarily considered a surgical condition. For acute cases or abscesses, the primary course of action aligns with standard abscess management, necessitating incision and drainage.
medtigo
Pilonidal Disease
Updated :
June 3, 2023
Pilonidal disease, also known as pilonidal sinus or cyst, is a common condition that affects the area at the top of the buttocks near the tailbone. It occurs when a hair follicle becomes blocked and infected, forming a cyst or sinus tract. Pilonidal disease is common in young adults, particularly in men. Other risk factors include a family history of the condition, obesity, a sedentary lifestyle, and excessive body hair.
The initial stage of pilonidal disease often involves the formation of a small cyst or abscess that can cause pain, swelling, and redness in the affected area. If left untreated or if the condition worsens, the cyst may become infected, developing a pilonidal sinus. The exact cause of pilonidal disease is not fully understood, but it is believed to be a combination of factors.
One contributing factor is the presence of hairs that can penetrate the skin and cause irritation. Friction or prolonged pressure on the affected area, such as sitting for long periods, can also play a role.
Pilonidal disease is a relatively common condition that primarily affects young adults, particularly males, although it can occur in individuals of any age or gender. Pilonidal disease is estimated to have an annual incidence of approximately 26 cases per 100,000 individuals. The incidence may be higher in certain populations, such as those with a higher prevalence of risk factors.
The pilonidal disease commonly affects individuals between the ages of 15 and 30, with the highest incidence occurring in the second and third decades of life. Males are more commonly affected than females, with a male-to-female ratio ranging from 2:1 to 5:1. Pilonidal disease occurs worldwide. However, there may be some variation in its prevalence among different countries and ethnic groups.
It has been reported to be more prevalent in certain regions, including North America, Europe, and the Middle East. Certain occupations that involve prolonged sitting or friction in the sacrococcygeal region, such as truck drivers, may have a higher incidence of pilonidal disease.
The exact pathophysiology of pilonidal disease is not fully understood, but it is believed to be multifactorial and involves a combination of anatomical, mechanical, and microbial factors. The primary contributing factor is the presence of hair follicles in the natal cleft. When hair penetrates the skin, it can irritate and trigger an inflammatory response. Certain anatomical factors, such as a deep natal cleft or excessive hair growth, can increase the likelihood of hair penetration and subsequent inflammation.
The mechanical aspect of the pilonidal disease involves friction and pressure on the affected area. Activities that involve prolonged sitting or repetitive trauma, such as cycling or truck driving, can exacerbate the condition. These mechanical forces can lead to hair follicle damage and subsequent inflammation. Microbial factors also play a role in pilonidal disease.
The area between the buttocks is prone to excessive sweating, which creates a warm and moist environment. This environment promotes the growth of bacteria and fungi, leading to infection and further inflammation. The combination of hair penetration, inflammation, mechanical factors, and microbial colonization can form a pilonidal sinus or abscess. The sinus or abscess is usually accompanied by pain, swelling, redness, and drainage of pus or blood.
The etiology of pilonidal disease, also known as pilonidal cyst or pilonidal sinus, is not fully understood. However, several factors have been identified that contribute to its development. The primary etiological factors of pilonidal disease include:
Congenital Factors: Some studies suggest that certain congenital factors may predispose individuals to develop pilonidal disease. These factors include a deep natal cleft, excess hair growth, and abnormal skin characteristics. These anatomical variations can contribute to hair entrapment and subsequent inflammation.
Hormonal Factors: Hormonal changes may play a role in the development of pilonidal disease. It is observed that the condition is more common in young adults, particularly males. Hormonal changes during puberty and increased hair growth during this time may contribute to the development of pilonidal disease.
Infection: Bacterial or fungal infection in the natal cleft area may contribute to the progression and exacerbation of pilonidal disease. The warm and moist environment between the buttocks is conducive to microbial growth. Infections can lead to increased inflammation, abscess formation, and the development of chronic or recurrent pilonidal disease.
Trauma or Friction: Repeated trauma or friction in the natal cleft area can contribute to the development of pilonidal disease. Activities that involve prolonged sitting, such as sitting on hard surfaces or long-distance driving, can increase the risk. The friction and pressure can cause hair to penetrate the skin and initiate the inflammatory process.
Pilonidal disease is generally considered a benign condition, although there have been rare reports of malignant transformation or development of skin cancer.
While the pilonidal disease can have a relatively high recurrence rate and may necessitate multiple procedures, the prognosis overall is favorable when appropriate lifestyle modifications are implemented, and an accurate diagnosis is made.
Clinical History
Patients often experience pain and discomfort in the sacrococcygeal region above the tailbone. The pain may range from mild to severe and can be aggravated by sitting, standing, or movement. The affected area may exhibit swelling and redness. The skin around the pilonidal sinus or abscess can appear inflamed and tender to the touch.
Hair might be visible in the sinus or abscess, as the condition typically involves hair follicle irritation and penetration. Pilonidal disease tends to recur, with symptoms flaring up periodically or persistently. Recurrence may result in the formation of multiple sinus tracts or abscesses.
Physical Examination
The presence of one or more sinus tracts or pits is a characteristic finding of pilonidal disease. These are small openings or depressions in the skin, typically located in the natal cleft (the area between the buttocks, near the tailbone). The sinus tracts may be visible as small holes or may be covered with hair. In some cases, pilonidal disease can progress to an abscess, a localized pus collection. Abscesses may appear as swollen, tender, and red areas of the skin.
Pilonidal disease can cause intermittent or chronic fluid drainage from the sinus tracts or abscesses. The drainage can vary in consistency and may include pus, blood, or clear fluid. The affected area may exhibit signs of inflammation, such as redness and increased warmth. Inflamed skin around the sinus tracts or abscesses can be tender to the touch.
Pilonidal disease is often associated with hair within the sinus tracts or pits. This can be observed upon examination, mainly if the sinus tracts are open. In cases of chronic or recurrent pilonidal disease, scarring, and fibrosis may develop. These can be observed as thickened or hardened areas of the skin in the affected region.
Differential Diagnoses
Anal Fistula
Epidural Abscess
Pilonidal disease is commonly regarded as a condition that necessitates surgical intervention, particularly in cases with acute occurrences accompanied by secondary infection and abscess formation. When infection or abscess is present, it is crucial to address and resolve the infection through incision and drainage procedures before definitive treatment can be pursued.
Various surgical options exist for treating pilonidal cysts and sinuses, and the choice of treatment should be tailored to each patient. It is important to incorporate lifestyle changes and address modifiable risk factors in the treatment plan. Given the role of hair in the development of pilonidal disease, hair removal, and epilation can be utilized as primary or complementary treatments without abscess.
Epilation methods may involve shaving, waxing, laser treatments, or creams. Additionally, fibrin and thrombin products have been employed as primary treatments or adjuncts to surgical techniques for managing pilonidal disease. Despite the availability of nonoperative approaches, the pilonidal disease is primarily considered a surgical condition. For acute cases or abscesses, the primary course of action aligns with standard abscess management, necessitating incision and drainage.
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