Pilonidal Disease

The first symptom of pilonidal disease is typically pain, especially when sitting. The degree of pain varies from person to person. Some people may experience a small degree of a pain when sitting, while others will be in severe pain.

Pilonidal disease often appears as a lump or swollen area that hurts when pressed with a finger. Pus or blood may or may not be draining from the lump. In some cases, a child may have a lump with some drainage and no pain. If the area becomes infected, the pus will be foul smelling and the area around it may become red and tender.

Seek medical attention right away if symptoms include nausea, fever, and exhaustion.

Pilonidal disease is caused by plugged hair follicles in the crease between the buttocks. Any type of hair can cause problems, but the most troublesome is coarse, thick hair. The plugged follicles may rupture into the deeper skin, creating an indentation, or pit, in the skin. If irritation under the skin continues, a pilonidal sinus, or tract, may form. This allows hair and other debris to travel under the skin and form a nest (a nidus), usually above the pit. This collection of hair and debris can get infected and an abscess may form. In severe pilonidals it is not unusual to have more than one abscess.

Factors that increase the risk of the follicles becoming plugged and rupturing include:

• Family history of pilonidal disease
• Sitting for a long time
• Activities such as horseback riding or bicycling that put extended pressure on the area
• Thick or coarse body hair
• Tight clothing
• Excess weight
• Tendency to sweat heavily

Pilonidal disease is diagnosed based on symptoms such as swelling and pain in the tailbone region. Carefully examining the buttocks crease may reveal holes in the skin.

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. If there is an infected pocket present, it may need to be drained. This can resolve the infection when combined with antibiotics.

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 cause a new abscess to appear. 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 the hair is and how fast it grows. You can use a regular razor, electric beard trimmer, or eyebrow shaper.

Chemical hair removal

Hair-removal cream or gel 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 about two to three minutes.

Permanent or near-permanent hair removal requires between four and eight laser treatments. 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.

Our Pilonidal Care Program treats children and teenagers with pilonidal disease. As part of the Department of Surgery, we specialize in treating pilonidal disease and preventing its reoccurrence.