II. Epidemiology
- Incidence: 70,000 cases in U.S. per year
- Infection occurs most often in males, age 16 to 30 (uncommon after age 40 years)
III. Risk Factors
IV. Pathophysiology
- Pit forms at skin disruption in gluteal fold (may be injured by embedded loose hairs)
- Pit plugs with hair and keratin
- Pilonidal Cysts form when drainage of pit is blocked, and abscess forms when infected
- Sinus tracts may also develop
V. Symptoms
- Pain in gluteal fold
- No systemic symptoms
VI. Signs
VII. Differential Diagnosis
- Hidradenitis Suppurativa
- Skin Furuncle or Skin Abscess
- Crohn Disease
- Perianal fistula
- Perianal Abscess
- Perirectal Abscess
- Squamous Cell Skin Cancer
VIII. Management: Pilonidal Disease without Abscess
IX. Management: Pilonidal Abscess
-
Incision and Drainage under Local Anesthesia
- Wear Personal Protective Equipment (including mask)
- Prepare the skin in typical fashion (Povidone Iodine or Chlorhexidine and draped)
- Lidocaine with epinephrine Local Anesthetic
- Make small incision lateral to midline (#11 or #15 Blade)
- Do not make incision in midline (risk of non-healing)
- Drain the abscess and break up adhesions with hemostat
- Wound packing is recommended for larger abscesses for the first 48 hours
- Apply a bulky, absorbent dressing
-
Antibiotic Indications
- Surrounding Cellulitis
- Immunocompromised patients
-
Wound care
- Patients should start with sitz baths at 24 hours after Incision and Drainage
- Consider surgical referral for cyst and sinus excision
- Routine surgical Consultation is typically recommended due to the high recurrence rate
- Many surgical approaches exist (e.g. marsupialization, Healing by Secondary Intention, flap closure)
- See recurrence rates below
X. Complications
- Pilonidal Abscess (surrounding Cellulitis may be present)
- Pilonidal Sinus Drainage
- Recurrent infections: 10 to 55%
- Abscess often recurrs in the same location
XI. References
- Marx (2002) Rosen's Emergency Medicine, p. 1952
- Sherman, Bahga and Vietvuong (2022) Crit Dec Emerg Med 36(7): 23-9
- Johnson (2019) Dis Colon Rectum 62(2): 146-57 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (MSH) | A hair-containing cyst or sinus, occurring chiefly in the coccygeal region. |
Concepts | Anatomical Abnormality (T190) |
MSH | D010864 |
ICD9 | 685 |
ICD10 | L05 , L05.91, L05.92 |
SnomedCT | 47639008, 200711002, 302223003, 156320006, 267837002, 302224009, 200716007 |
English | Cysts, Pilonidal, Pilonidal Cysts, Pilonidal Sinus, Cyst, Pilonidal, PILONIDAL CYST, Sinus, Pilonidal, Pilonidal sinus/cyst NOS, PILONIDAL SINUS, Pilonidal sinus/cyst, pilonidal cyst, pilonidal cyst (diagnosis), Pilonidal cyst NOS, Pilonidal cyst and sinus, Pilonidal Sinus [Disease/Finding], pilonidal cyst sinus, Cyst;pilonidal, Fistula;pilonidal, pilonidal sinus cyst, pilonidal sinus/cyst (non-specific), pilonidal cysts, sinus pilonidal, coccygeal sinus, cyst pilonidal, pilonidal sinus, pilonidal sinus (diagnosis), Pilonidal sinus/cyst (disorder), Pilonidal sinus (finding), Sinus - pilonidal, Cyst - pilonidal (finding), Pilonidal sinus/cyst NOS (disorder), Coccygeal sinus, Pilonidal sinus, Coccygeal fistula, Piliferous cyst, Pilonidal fistula, Cyst - pilonidal, Cyst - pilonidal (disorder), Pilonidal cyst, coccyx; sinus, cyst; pilonidal, fistula; pilonidal, pilonidal; cyst, pilonidal; fistula, pilonidal; sinus, sinus; coccygeal, sinus; pilonidal, Pilonidal cyst, NOS, Pilonidal Cyst, pilonidal fistula, Sinus;pilondial |
French | KYSTE PILONIDAL, Kyste pilonidal, Sinus pilonidal |
Spanish | QUISTE PILONIDAL, Seno pilonidal, quiste/fístula pilonidal, SAI, quiste/fístula pilonidal, SAI (trastorno), fístula coccígea, fístula pilonidal, quiste pilonidal (trastorno), quiste pilonidal, quiste pilífero, seno coccígeo, seno pilonidal, Quiste pilonidal, Quiste Pilonidal, Seno Pilonidal |
German | PILONIDALZYSTE, Sinus pilonidalis, Pilonidalsinus, Pilonidalzyste |
Swedish | Pilonidalcysta |
Japanese | モウソウノウホウ, モウソウドウ, ピロニダールサイヌス, 毛巣洞, 毛巣嚢胞, 毛巣嚢腫, 毛巣瘻 |
Czech | pilonidální sinus, pilonidální cysta, Pilonidální cysta, Pilonidální dutina |
Finnish | Pilonidaalisinus |
Russian | EKTODERMAL'NYI KRESTTSOVO-KOPCHIKOVYI SINUS, PILONIDAL'NAIA KISTA, PILONIDAL'NYI SINUS, EPITELIAL'NYI KOPCHIKOVYI KHOD, ПИЛОНИДАЛЬНАЯ КИСТА, ПИЛОНИДАЛЬНЫЙ СИНУС, ЭКТОДЕРМАЛЬНЫЙ КРЕСТЦОВО-КОПЧИКОВЫЙ СИНУС, ЭПИТЕЛИАЛЬНЫЙ КОПЧИКОВЫЙ ХОД |
Portuguese | QUISTO PILONIDAL, Sinus pilonidal, Quisto pilonidal, Cisto Pilonidal, Seio Pilonidal |
Italian | Cisti pilonidale, Seno pilonidale |
Dutch | pilonidale sinus, coccygeus; sinus, cyste; pilonidaal, fistel; pilonidaal, pilonidaal; cyste, pilonidaal; fistel, pilonidalis; sinus, sinus; coccygeus, sinus; pilonidalis, pilonidaliscyste, Pilonidaal cyste, Sinus pilonidalis |
Korean | 모소낭 |
Polish | Torbiel pilonidalna, Torbiel zawierająca włosy, Torbiel włosowa, Zatoka włosowa |
Hungarian | pilonidalis cysta, Pilonidalis sinus |
Norwegian | Sakralcyster, Tvillingcyster, Pilonidal sinus |
Ontology: Pilonidal sinus with abscess (C0342988)
Concepts | Disease or Syndrome (T047) |
ICD10 | L05.02 |
SnomedCT | 156321005, 200714005 |
English | pilonidal sinus with abscess (diagnosis), Pilonidal sinus with abscess, Pilonidal sinus with abscess (disorder), pilonidal; sinus, with abscess, sinus; pilonidal, with abscess |
Dutch | pilonidalis; sinus, met abces, sinus; pilonidalis, met abces |
Spanish | seno pilonidal con absceso (trastorno), seno pilonidal con absceso |
Ontology: Pilonidal disease (C2317114)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 432863009 |
English | Pilonidal disease (disorder), Pilonidal disease, pilonidal disease (diagnosis) |
Spanish | enfermedad pilonidal, enfermedad pilonidal (trastorno) |