Pilonidal Disease: Symptoms, Causes & Treatment

Pilonidal disease (pilonidal sinus) is a skin condition in which a small cavity or tunnel forms under the skin in the upper area of the buttock cleft near the tailbone, often containing hair and dead skin cells. It is thought that hair growing in the area penetrates the skin and embeds in it, triggering cyst formation and an inflammatory reaction.

The cyst may remain silent without symptoms, but it often becomes inflamed and turns into a painful abscess: a red, swollen, painful lump appears near the tailbone, with warmth and sometimes foul-smelling pus or blood discharge, possibly with fever. It is more common in young people from adolescence to the mid-twenties, especially males, and is linked to factors such as prolonged sitting, dense hair, obesity, and friction and sweating in the area.

Treatment depends on its state: with an acute painful abscess, the immediate treatment is draining the pus through a small incision to ease pain. A recurrently inflamed or chronic cyst usually needs surgery to fully remove it, with various surgical techniques and wound-closure methods. Treatment is complemented by the importance of caring for the area: keeping it clean and dry, removing hair from it regularly, and avoiding prolonged sitting, to reduce recurrence risk. Early evaluation when symptoms appear prevents the abscess from worsening.

• A red, swollen, painful lump near the tailbone at the top of the buttock cleft.
• Warmth and foul-smelling pus or blood discharge.
• Pain that worsens on sitting.
• Sometimes fever when an abscess is present.

• Hair penetrating and embedding in the skin, triggering cyst formation and inflammation.
• Friction, sweating, and prolonged sitting in the area.
• Dense hair, obesity, and poor hygiene of the area.

• Male sex and ages from adolescence to the mid-twenties.
• Prolonged sitting (drivers, office workers).
• Dense coarse hair, obesity, and sweating.

• Clinical diagnosis from the appearance and characteristic location of the cyst or abscess.
• Examination to rule out other similar conditions when needed.

With an acute abscess

• Draining the pus through a small incision to ease pain immediately.
• Antibiotics when infection spreads, by prescription.

Recurrent or chronic cyst

• Surgery to fully remove the cyst, with various techniques and closure methods.

Care and prevention

• Keeping the area clean and dry, removing hair regularly, and avoiding prolonged sitting.

This content is educational and does not replace consulting a surgeon.

• Recurrent abscess and chronic infection.
• Formation of fistulas and channels under the skin.
• Slow wound healing after surgery and recurrence.

• Keeping the area clean and dry.
• Removing hair from the area regularly.
• Avoiding prolonged sitting and maintaining a healthy weight.