Pilonidal Disease
What is Pilonidal Disease?
Pilonidal disease is a condition where a pit or sinus appears in the skin in the gluteal cleft (around the “tail bone”). It usually presents after your child has hit puberty, and is more common in people with extra body hair, but can happen to anyone.
It is not clear what causes it, although there are a number of theories. The most commonly accepted is that a hair falls from the head and lands in between the buttocks. It burrows in to the skin because the buttocks rub together as you walk, and once under the skin causes a foreign body reaction. Once a tunnel in the skin forms, more hairs and bacteria can get in, which predisposes to more inflammation, and infection.
Pilonidal sinus is the presence of the pit, with or without chronic inflammation. This is frustrating and uncomfortable, but not a surgical emergency.
Pilonidal abscess occurs when an infection occurs under the skin, and pus accumulates and causes severe pain and pressure. This is a surgical emergency, as the infection can make your child unwell, and at the very least is severely painful.
OUTCOMES
Pilodinal disease is a frustrating entity, as even with surgery, there is a relatively high relapse rate.
Repeated operative interventions is to be expected, and the condition can continue well in to adulthood.
Non operative management can reduce the risk of recurrence, and includes hygeine measures, weight loss, avoiding prolonged sitting and hair reduction strategies such as shaving, waxing and laser therapy.
DR ROB’S APPROACH
Dr Rob offers management of pilonidal disease to patients under the age of 16. After the age of 16, he recommends referral to the colorectal service at the Gold Coast University Hospital.
Pilonidal abscess is an emergency condition, with the priority being drainage of the pus through an incision away from the midline pit. This is not expected to cure the pilonidal disease but will reduce the severe symptoms related to the bacterial infection.
Dr Rob performs a Gipps procedure for the management of pilonidal sinus. Recurrent cases can expect up to 3 Gipps procedures to be performed for relapsing disease. There is no consensus as to the best way to managed complex surgically refractory disease, and Dr Rob will discuss your options with pros and cons at length in the rare situation that more significant surgery is needed.
DR ROB McCUSKER
Gold Coast Children’s Surgeon
Dr Rob is dedicated to the highest quality of care and technical excellence for his patients.