What is pilonidal disease?

Updated: Jun 11, 2018
  • Author: M Chance Spalding, DO, PhD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Pilonidal disease was first reported in 1833. This process was first described by Anderson in 1847 and later named pilonidal sinus by Hodges in 1880. [1] The word pilonidal derives from the Latin words pilus ("hair") and nidus (“nest”).

Sacrococcygeal pilonidal sinus is a common disorder among young adults. Observed most commonly in people aged 15-30 years, with a 3:1 male-to-female ratio, it occurs after puberty, when sex hormones are known to affect the pilosebaceous gland and change healthy body hair growth. The onset of pilonidal disease is rare in people older than 40 years. [2]

In the 1950s, pilonidal sinus disease was thought to be of congenital origin rather than an acquired disorder. The pilonidal sinus and abscess were thought to be secondary to a congenital remnant of an epithelial-lined tract from postcoccygeal epidermal cell rests or vestigial scent cells. Sinuses to the neural canal can occasionally extend to the dura, but these are rare and are located in the lumbar region rather than in the sacral region.

Pilonidal disease is now widely considered to be an acquired disorder, on the basis of observations that congenital tracts do not contain hair and are lined with cuboidal epithelium. The pilonidal cyst is also not a true cyst, in that it has an epithelialized walls and is more of a cavity, which makes a congenital origin less likely. The recurrence of the disorder after complete excision of the disease tissue down to the sacrococcygeal fascia and the high incidence of chronic pilonidal sinus disease in patients who are hirsute further support an acquired theory of pathogenesis.

In a census and survey of patients admitted to British hospitals in 1985 for treatment of pilonidal sinus disease, it was found that 7000 patients required hospitalization for an average of 5 days. The hospitalization of these patients for the treatment of pilonidal disease resulted in a loss of productivity and earnings, as well as a disruption of education, because patients recovered in the hospital. In the 1980s, Bascom found that at least 40,000 US soldiers were admitted to the hospital for an average of more than 5 days of inpatient care for pilonidal disease and associated complications.

Treatment options are now available that provide a rapid rate of cure and a lower recurrence rate and minimize the number of hospital admissions. Although numerous randomized clinical studies have evaluated different treatments, no clear consensus has been reached as to the optimal medical or surgical treatment of pilonidal disease.

For patient education resources, see the Skin Conditions and Beauty Center, as well as Pilonidal Cyst and Skin Abscess.

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