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- Pilonidal disease results from an abscess, or sinus tract, in the upper part of the natal (gluteal) cleft.
- Synonym(s): jeep disease
- 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
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
- Congenital dimple in the natal cleft/spina bifida occulta
- Follicular-occluding tetrad: acne conglobata, dissecting cellulitis, hidradenitis suppurativa, pilonidal
- Sedentary/prolonged sitting
- Excessive body hair
- Obesity/increased sacrococcygeal fold thickness
- Congenital natal dimple
- Trauma to coccyx
- Weight loss
- Trim hair in/around gluteal cleft weekly.
- Ingrown hair prevention/follicle unblocking