Pilonidal disease is a condition in which an abnormal pocket in the skin of the lower back is found, usually near the tailbone at the top of the cleft of the buttocks. The cyst may cause virtually no symptoms, with possibly only a bit of redness and swelling in the tailbone region — or it may become an open, infected wound that drains for years, causing irritation, pain and embarrassment.
The condition tends to be found chiefly in teenagers and young adults between 15- and 24-years-old (males more than females).
No one knows exactly what causes pilonidal disease. Some have proposed that hair follicles in the midline of the lower back get blocked and cause a cycle of inflammation and infection leading to abscess formation and a chronic wound. Others suggest that bits of hair from other parts of the body can get caught in a small opening in the skin of the lower back and cause this same cycle of inflammation and infection.
No matter the cause, patients with pilonidal disease can have multiple, recurring bouts of infection and discomfort. Some undergo repeat drainages of abscesses. Some undergo many surgeries in an attempt to remove the abscesses or cysts from the affected area. Too often, these operations fail to fully eradicate the disease.
An active pilonidal abscess must be drained, and this can usually be done in the emergency room or the office under local anesthesia. After the urgent problem is addressed, a measured plan of action must be undertaken to prevent recurrence or worsening of symptoms. While antibiotics and warm soaks are often prescribed and may offer symptomatic relief, surgical removal of the problem is usually necessary.
Non-surgical approaches include the application of phenol or other scarring agents to eradicate the area of chronic inflammation and laser hair removal to avoid hair entrapment. The surgeons at Lurie Children’s do not recommend these approaches as primary, or sole, treatments.
The surgeons in the Division of Pediatric Surgery offer two approaches to pilonidal disease.
Where the only signs and symptoms have been an abscess and/or pain and swelling, the small open area at the base of the tailbone (the pilonidal pit) is removed under local anesthesia, either in the operating room or in the office. By eliminating the area where hair follicles can get blocked and cause inflammation and infection, most patients can avoid having further complications of pilonidal disease.
For open, chronic wounds and recurrent infections, more extensive surgeries are offered. One of the operations, known as the Bascom cleft lift procedure, was pioneered by two surgeons in Oregon for adult patients and has been adapted for children by a handful of pediatric surgeons across the US. The surgery, done under general anesthesia in the operating room, involves removing the affected tissue and covering the area with healthy tissue. A small suction drain is left under the skin to prevent swelling. The drain is removed two or three days after the surgery when patients come back for a postoperative visit. All procedures are done on an outpatient basis and take about 1–1½ hours.