(See also Evaluation of Anorectal Disorders.)
Pilonidal disease usually occurs in young, hirsute, white males but can also occur in women. One or several midline or adjacent-to-the-midline pits or sinuses occur in the skin of the sacral region and may form a cavity, often containing hair. The lesion is usually asymptomatic; infected lesions are painful.
Treatment of an acute abscess is by incision and drainage. Usually, one or more chronic draining sinuses persist and must be extirpated by excision and primary closure or by an open technique (eg, cystotomy, marsupialization). Minimally invasive techniques that use endoscopic or video assistance have also been used with some success but require specialized equipment and expertise. Antibiotics are typically not needed. (See also the American Society of Colon and Rectal Surgeons’ clinical practice guidelines for the management of pilonidal disease.)
Larger cysts may require a rotation flap to close the defect.