Pilonidal Disease

Our team at UCSF BCH of surgeons and nurses has special expertise in pilonidal disease and takes a comprehensive approach towards it, treating patients from throughout Northern California. Pilonidal disease is an infection in the gluteal cleft, or the buttock crease. It is a common condition that perhaps does not often get the attention that it deserves, as it can be very painful and debilitating. Pilonidal disease includes pilonidal cysts, which are cysts formed over time from chronic disease, pilonidal abscesses which are acute infections of pilonidal disease with the formation of an abscess, and pilonidal sinuses which are openings in the skin that lead to deeper infections.  

What causes pilonidal disease? 

Pilonidal disease occurs most commonly in teenagers and young adults. It is more common in males than females. People who have more hair in their lower back and buttocks are more susceptible to pilonidal disease. It is thought that the initial event is an ingrown hair in the region which causes inflammation and an infection. Sometimes, this will be self-limited and resolve on its own. However, it can also lead to a bigger infection and lead to an abscess (an infected pocket with pus). Over time, with repeated infections, cysts or sinus tracks can develop which may lead to chronic disease.  

How is pilonidal disease diagnosed? 

Pilonidal disease is best diagnosed by having an experienced provider examine the lower back area and gluteal cleft. They may see swelling and redness in the area which usually indicates an abscess or small holes which may have pus draining as well as hairs within them. Often, the region is very tender to touch.  

How is pilonidal disease treated? 

We have close follow-up for our patients with pilonidal disease and it requires both surgical and non-surgical treatments. It is important to shower or bathe at least daily to clean the area. Most important is to let clean water run over the area. If you bathe, putting Epsom’s salt into the bath may be helpful.  This is also referred to as a Sitz bath.  Minimizing hair is also important and this can be achieved by either shaving the area or, in certain cases, laser hair removal.   

If an abscess develops, a surgeon may need to perform an incision and drainage procedure to allow the pus to drain out. Sometimes a drain may be placed to make sure all of the pus comes out before the skin heals over the incision site. Antibiotics may also be given to help clear the infection.  

If repeated infections occur, then further surgery may be needed.   We first try a minimally invasive approach, or a pit-picking approach.  This consists of excising any sinus tracks, removing the ingrown hairs from underneath the skin, and then cleaning out the infected tissue.  Pit-picking may be needed several times but most patients who undergo pit-picking have resolution of their pilonidal disease. If infections continue to occur, then a bigger operation may be needed. This consists of excising the infected area and then performing a gluteal cleft lift which flattens out the upper part of the gluteal cleft allowing it to heal better. We have excellent results with excision and gluteal cleft lift. Nearly all of these surgeries can be performed as an outpatient procedure.