Pilonidal Disease Needs Comprehensive, Long-Term Care

Pilonidal disease is a chronic condition that can cause discomfort and sometimes embarrassment for adolescents and young adults. But recent innovations in managing the condition have helped patients cope and get back to enjoying their lives.

The first sign of pilonidal disease is often a small, hard bump in the crack between the buttocks, at the base of the tailbone. Parents may notice their child turning to the side when they sit or lying on their tummy because it hurts to lie on their back.

Symptoms to notice include:

• A tiny pit or pimple at the cleft of the buttocks.
• Tufts of body hair growing in the pit.
• Pus or blood draining in the area.
• Pain when sitting.
• Bad smell.

“Pilonidal disease is more common among adolescents than younger children possibly due to hormonal changes that spur hair growth. The disease is also associated with people who have a lot of hair,” notes Stanford Medicine Children’s Health surgeon Wendy Su, MD.

Since bacteria can be trapped in the buttocks cleft, the area can easily become infected. The condition should be tended to by a pediatrician or pediatric surgeon to prevent an abscess or other infection.

There are several options for treating pilonidal disease.

• Hygiene. Showering or bathing two to three times every day can minimize bacterial growth, which prevents infections. This is especially important if your child is overweight or obese, or has a lot of body hair.

• Hair removal. If your child is very hairy, get the hair removed in the location where the pilonidal disease occurs. Laser hair removal is highly effective for this purpose.

• Surgery. The tiny pit can be removed entirely by a pediatric surgeon. The earlier the disease is treated, the more likely an infection can be prevented.

Or, a surgeon can perform a procedure that goes deeper than just the visible pit, to clean out the entire pocket and remove the hair that is under the skin. After surgery, it’s important to follow the provider’s instructions for managing the wound to ensure that it heals completely.

According to surgeon Bill Chiu, MD, “Surgical options have been refined in recent years to create superior results with a combination of techniques.” They include:

• A tiny incision to remove the pit and hair growing in it. This is called a Gips procedure.
• Aggressive attention to wound care before and after surgery.
• Use of lasers to completely remove hair from the area.

A surgeon can also flatten out the entire area of the buttocks where the disease is present, with good results in terms of controlling infections. Dr. Su notes that this procedure often doesn’t appeal to young people, as the result is a much smaller backside.

Controlling pilonidal disease is possible with comprehensive care that occurs over the long term.