What Is Pilonidal Disease?
Pilonidal disease is a chronic inflammatory skin condition involving the hair follicles that happens anywhere along the crease between the buttocks— from the tailbone to the anus. This is a benign disease and has no association with cancer. However, a pilonidal disease can be excruciatingly painful, especially when sitting. Therefore, the pilonidal disease should be treated on time.
The untreated chronic pilonidal disease can also result in abscesses (swollen pockets of infection) and sinus cavities (hollow cavities underneath the skin). The pilonidal disease most commonly occurs in young men, and the problem tends to recur. In addition, people who sit for prolonged periods, including truck drivers, are at more risk of developing a pilonidal disease. It is a non-contagious skin condition that cannot spread from one to another. During World War II, pilonidal cysts were frequently called jeep driver's disease as they were more common in people who sit for prolonged periods.
Who Can Get the Pilonidal Disease?
Although anyone can get a pilonidal disease, certain people are at higher risk of developing this disease:
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Men are more likely to develop pilonidal disease than women.
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People between puberty and age 40.
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People involved in an occupation requiring prolonged sitting, like truck or taxi drivers and office workers.
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People who are obese or overweight.
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People with thick, stiff, or coarse body hair.
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People who wear tight clothes (doing so can also worsen their skin condition).
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Male sex.
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People with an inactive lifestyle.
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People with excess body hair.
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Pregnant women can also get them. Pain in the buttocks may signify pilonidal disease and not just a normal pregnancy discomfort. It is best, in that case, to contact a healthcare provider and get it checked.
Is a Pilonidal Disease a Genetic Disease?
In some instances, a pilonidal disease can be hereditary; one can inherit it from a family member. The family history can determine if one gets a pilonidal disease, for example, if rough or coarse body hair runs in the family.
What Causes a Pilonidal Disease?
The exact cause of pilonidal disease is still unclear. However, researchers believe that the ingrown hairs found in the crease of the buttocks lead to a skin infection that leads to the formation of pilonidal cysts. The disease can result in an abscess or a sinus cavity if left untreated. These signs indicate that the skin infection is getting worse.
What Are the Signs and Symptoms of Pilonidal Disease?
Immediately seek medical assistance if one notices any of the following symptoms:
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Pain that aggravates while sitting.
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A small dent (depression) or large swollen area (pilonidal cyst) between the buttocks. This area is often red and feels tender.
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Drainage of pus or blood from an opening in the skin (abscess), causing a foul smell.
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Nausea, fever, and fatigue.
How Is a Pilonidal Disease Diagnosed?
Diagnosis is commonly confirmed by a healthcare provider examining the buttock area. The provider may also perform a complete physical examination. During the exam, they will check the crease of the buttocks for signs of pilonidal disease, such as a pimple or oozing cyst. Very rarely, the healthcare provider may order other diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI) to look for any sinus cavities (little holes) that may have formed under the surface of the skin.
How Is a Pilonidal Disease Treated?
Once diagnosed, the provider recommends a treatment plan that best fits an individual case. Depending on the disease, one may or may not need surgery to remove the pilonidal cyst.
In addition, there are several other treatment approaches available besides surgery, including:
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Draining the Cyst: This procedure is performed in a provider's office under local anesthesia. A small incision opens and drains fluid from the infected cyst, reducing inflammation and pain. If there is significant skin inflammation, antibiotics may be prescribed. In addition, keeping hair out of the affected area can help treat active and chronic diseases.
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Antibiotics: Antibiotics can alleviate skin inflammation.
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Injections: Localized phenol injections (an acidic chemical compound) can help treat and prevent mild and moderate pilonidal disease.
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Laser Therapy: Laser treatment can remove hair that might become ingrown and cause pilonidal disease to return.
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In the meantime, one can try to manage pain by using a warm compress on the affected area to soothe the skin. Using an inflatable seat or mattress can also help alleviate pain to some extent.
Surgical Treatment:
For chronic pilonidal cyst or if it has gotten worse and formed a sinus cavity under the skin, surgery to excise (remove) the cyst entirely is necessary. Afterward, the surgeon may leave the wound open for packing (inserting gauze) or close the wound with sutures or a skin flap (a piece of skin taken from a healthy body area).
Post-Operative Care:
After surgery, it is essential to take good care of the wound, so it does not get infected. The provider often gives detailed instructions on how to clean the damage (including shaving around the surgical area to prevent hairs from entering the wound), how long to keep it covered, and what to expect from a normal healing process. They also tell the warning signs of infection and when to call the healthcare provider.
What Is the Outlook for People With Pilonidal Disease?
Pilonidal cysts, in some cases, drain and disappear on their own. However, the symptoms may come and go over time in chronic cases. The pilonidal disease can remain a chronic, returning condition even after surgery, significantly if the condition has worsened or pilonidal disease runs in the family.
How Can Pilonidal Cysts Be Prevented?
Several steps can help prevent pilonidal disease or keep them from recurring.
These steps include:
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Daily clean and dry the buttocks.
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Lose weight to lower the risk.
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Avoid prolonged sitting, and keep changing the positions to keep pressure off the area.
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Shave the hair around the buttocks (once a week or more) to avoid the risk of recurrence. Use a hair removal cream to avoid getting ingrown hairs.
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Use a soft-bristled scrub brush to prevent the hair from becoming ingrown.
What Are the Potential Complications of Pilonidal Disease?
Pilonidal disease is not life-threatening in itself. However, besides the severe pain, there is always a possibility that a cyst can pose several long-term health issues, including:
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Recurrence of the disease.
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Systemic infection.
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Rarely, an untreated chronic pilonidal disease can lead to a type of skin cancer called squamous cell carcinoma.
Conclusion
Pilonidal disease is a chronic inflammatory skin condition involving the hair follicles that happens anywhere along the crease between the buttocks. Although a pilonidal cyst is not fatal, it can become more challenging to treat and become a chronic condition if medical care is not sought promptly. That is why getting a diagnosis at the first sign of the pilonidal disease is essential. In addition, always be open with the healthcare provider about the symptoms and concerns.
