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Pilonidal Disease

Pilonidal Disease is a topic covered in the 5-Minute Clinical Consult.

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Basics

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 >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%)

  • 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

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Citation

Stephens, Mark B., et al., editors. "Pilonidal Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116455/all/Pilonidal_Disease.
Pilonidal Disease. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116455/all/Pilonidal_Disease. Accessed April 24, 2019.
Pilonidal Disease. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116455/all/Pilonidal_Disease
Pilonidal Disease [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116455/all/Pilonidal_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pilonidal Disease ID - 116455 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116455/all/Pilonidal_Disease PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -