A painful or draining opening near the tailbone may represent pilonidal disease. What is visible on the skin can be small even when pits or tunnels extend farther beneath the surface.
The key distinction
A sudden painful pocket of infection (abscess) and ongoing pilonidal disease are related problems, but they are not treated exactly the same way.
What is pilonidal disease?
Pilonidal disease develops in the cleft between the buttocks, usually near the tailbone. Small skin pits along the center of the cleft can trap hair and debris and may connect to tunnels beneath the skin. Some people have little or no discomfort, while others develop drainage or inflammation that keeps returning, or a painful abscess.
What does a pilonidal abscess feel like?
An abscess usually causes increasing pain, swelling, tenderness, and redness near the top of the cleft. Drainage and fever can occur. A true abscess generally requires prompt evaluation because simply waiting for it to resolve may prolong symptoms or allow the infection to worsen.
Drainage treats the infection, not necessarily the underlying disease.
Incision and drainage is often the appropriate first treatment for an acute abscess. Once the infection settles, some patients never have another episode. Others continue to have pits, drainage, or recurrent abscesses and should be evaluated for a longer-term treatment plan.
Chronic or recurrent disease has more than one surgical option.
There is no single operation that is best for every patient. Surgical choices depend on the number and location of skin pits, how far the tunnels extend, whether prior operations have failed, the shape and depth of the cleft, and the surgeon’s experience with the available techniques.
When a wound is closed primarily, modern guidance favors closing the incision to one side of the cleft when possible because this approach has generally been associated with better wound healing and a lower chance of the problem returning than closure directly in the center.
What about hair removal and hygiene?
Keeping the cleft clean and minimizing loose hair may be part of ongoing care, but aftercare should be individualized. Recurrent disease is not simply a hygiene problem, and patients should not be blamed when the condition returns after an otherwise appropriate treatment.
Dealing with repeated pilonidal flare-ups?
Dr. Zadeh evaluates pilonidal disease in Sherman Oaks, including recurrent disease and prior treatment failures.