Diagnosis

Pilonidal disease

Etiology

Cause [7e5]

• Hair from the skin trapped in the pilonidal cysts --> foreign body reaction/granuloma

Pathophysiology

1. Sex hormones affect the pilosebaceous glands production

2. Trapped hair follicles --> distension --> folliculitis --> edema --> follicle occlusion

3. The infected follicle expands and ruptures into the subcutaneous tissue --> pilonidal abscess

Risk factors

• Sweating

• Buttock friction

• Poor personal hygiene

• Obesity

• Local trauma

Complications [7e5]

• Recurrence

• Osteomyelitis

• Malignant transformation

Epidemiology

Incidence per 100.000 [vwa][bic]

Approach

• Blood test

• Culture

• Anoscopy

Treatment

1. Prophylaxis: Laser epilation [3nm][7e5]

2. Nonoperative management: no abscess, only cellulitis

   • Phenol injections

   • Antibiotics

3. Surgery when abscess: [3nm]

   • Acute abscess: Incision and drainage

   • Definitive treatment: Excision and primary paramedian closure plus antibiotics

   • Recurrent or refractory: Flap-based procedures -> Bascom ‘cleft lift’

Differential diagnoses

Anal fissure, Anorectal abscess, Anorectal fistula, Cellulitis, Crohn disease, Erysipelas, Folliculitis, Furunculosis, Hidradenitis suppurativa, Osteomyelitis, Syphilis, Tuberculosis, Ulcerative colitis