Pilonidal Disease

A pilonidal sinus is a small tunnel in the skin at the top of the natal cleft that becomes filled with hair and debris. It most often affects young adults, particularly men, and is more common in people who have coarse body hair, sit for long periods or have a deep natal cleft.

It may cause no symptoms, a persistent discharging pit, or repeated painful abscesses that need to be drained.

A pilonidal abscess is treated by incision and drainage, a short procedure under local or general anaesthetic that relieves pain quickly. Antibiotics alone are rarely enough. Drainage treats the infection but does not remove the sinus, so many patients go on to have further episodes.

For recurrent or chronic disease a definitive operation is recommended. Options range from minimally invasive pit-picking or laser treatment for limited disease through to excision of the sinus tract. Where excision leaves a larger wound, it may be closed with a flap (such as a Karydakis or Bascom cleft lift procedure) that moves the scar away from the midline, which heals more reliably and reduces the chance of recurrence.

Your surgeon will recommend the approach that best suits the extent of your disease, and most procedures are performed as day surgery.

Recovery depends on the procedure and whether the wound is closed or left to heal from the base. Keeping the area clean and free of hair, with regular shaving or laser hair removal, reduces the risk of the problem coming back. Most people return to work and normal activities within one to two weeks.