Pilonidal Disease | Diagnosis and Treatment

How is pilonidal disease diagnosed?

Pilonidal disease is diagnosed based on symptoms such as swelling and pain in the tailbone region.

How is pilonidal disease treated?

There are a few different treatment options for children with pilonidal disease, depending on the severity. Sometimes when a pilonidal abscess first appears, doctors treat it with antibiotics and suggest home hygiene, including shaving and regularly cleaning the infected area. More severe cases often require surgery.  

Hair Removal

Hair removal is the most important thing you can do to treat pilonidal disease. Even one hair can keep the cut from healing or can make a new abscess show up. A family member or clinician will most likely need to help with home hair removal.

Hair removal methods

Shaving

The area between the buttocks may need to be shaved every week, depending on how thick hair is and how fast it grows. You can use regular razors, electric beard trimmers or eyebrow shapers. 

Chemical hair removal

Hair-removal cream or gel to removes hair and keeps it from growing back for longer. Make sure to keep the cream away from any broken skin and the anus.

Laser hair removal

Some people have an excessive amount of hair that cannot be managed by shaving alone. In such cases, the medical team may recommend laser hair removal.

Laser hair removal is a safe procedure that can be performed in a physician’s office. This treatment can cause mild discomfort but is usually well tolerated. The entire treatment takes around two to three minutes.

It takes at least six laser treatments for permanent or near-permanent hair removal. Treatments are six to eight weeks apart. Waiting too long between treatments will cause your child to need extra laser treatments, so it is important to schedule timely laser treatments.

Hygiene
Your doctor may recommend regularly cleaning the area to remove all bacteria, debris, loose hairs and sweat on the skin of the buttock crease. You can do this by:

  • soaking in a bath for 10 to 15 minutes, two to three times a day
  • spraying the buttock area with a hand-held shower head for 10 to 15 minutes, two to three times a day
  • sitting in a Jacuzzi, pool or ocean for 10 to 15 minutes, two to three times a day

Drainage

If the pilonidal abscess is not draining on its own, it may need to be drained in a doctor’s office or emergency room.

Surgical Treatments

Some patients with pilonidal disease will need to surgery. The surgery takes place under general anesthesia in an operating room. Your surgeon will discuss the best surgical option for you or your child.

Surgical procedures include:

  • Removing the infection and closing the cut: The surgeon removes the pilonidal abscess, tracts and the infected fat and skin, closing the cut with stitches. This procedure is a quick way of removing a pilonidal abscess, but there is a real chance that the abscess may come back after the operation. 
  • Removing the infection and leaving the cut open: The surgeon removes the pilonidal abscess, tracts and the infected fat and skin, but leaves the skin of the cut open and fills it with gauze. This allows the cut to heal from the inside out. This operation takes longer to heal than closing the cut, but makes it less likely that the abscess will come back. 
  • Removing the infection and filling the site with a skin flap: The surgeon removes the pilonidal abscess, tracts and infection, then uses healthy skin, fat, and muscles from another part of the buttocks to fill up the space where the abscess was. This may be a good option when other treatments have not worked well.