Pilonidal Disease

Description

• Pilonidal disease results from an abscess, or sinus tract, in the upper part of the natal (gluteal) cleft.
• Synonym(s): jeep disease

Epidemiology

Incidence

• 16 to 26/100,000 per year
• Predominant sex: male > female (3 to 4:1)
• Predominant age: 2nd to 3rd decade, rare in age >45 years
• Ethnic consideration: whites > blacks > Asians

Prevalence
Surgical procedures show male:female ratio of 4:1, yet incidence data are 10:1.

Etiology and Pathophysiology

Pilonidal means “nest of hair”; hair in the natal cleft allows hair to be drawn into the deeper tissues via negative pressure caused by movement of the buttocks (50%); follicular occlusion from stretching and blocking of pores with debris (50%) creating a pilonidal cyst

• Inflammation of SC gluteal tissues with secondary infection and sinus tract formation
• Polymicrobial, likely from enteric pathogens given proximity to anorectal contamination

Genetics

• Congenital dimple in the natal cleft/spina bifida occulta
• Follicular-occluding tetrad: acne conglobata, dissecting cellulitis, hidradenitis suppurativa, pilonidal

Risk Factors

• Sedentary/prolonged sitting
• Excessive body hair
• Obesity/increased sacrococcygeal fold thickness
• Congenital natal dimple
• Trauma to coccyx

General Prevention

• Weight loss
• Trim hair in/around gluteal cleft weekly.
• Hygiene
• Ingrown hair prevention/follicle unblocking