All I see is pits – do I need to worry?
Pilonidal disease occurs because of a deep gluteal cleft. Pressure develops in the cleft, and causes pores in the midline to enlarge. If one looks carefully, there can be one or several of these enlarged pores in a vertical line along the crease in patients with pilonidal disease.
Frequently, I am asked what to do about this. The answer depends on the presence of symptoms, and the personal philosophy regarding being proactive vs. waiting to see what happens.
If there are no symptoms, a reasonable strategy is to see if you can get these pores to resolve. The best way to do that is to prevent the crease from being folded as much as possible. If you are wearing any kind of stretch pants, shorts, tights, or underwear that is compressing the buttocks – wearing looser clothes may set the stage for this to reverse. You can read more about clothing choices on this page. Another way to break up the pressure gradient in the crease is to tuck a piece of gauze in the crease next to the pits. If pressure in the crease is relieved, the pits may resolve.
If there is pain, tenderness, a lump, bleeding, drainage, or a previous infection (abscess) then there is most likely a cyst under the skin, and the odds are that this will eventually cause symptoms or problems in the future. In that case, it’s reasonable to consider some sort of surgical treatment. Depending on the surgeon you see, recommendations may vary. In our clinic, we feel that if a patient is going to undergo a surgical procedure, that the cleft-lift is best, and in this situation has about a 100% success rate. Other surgeons have different strategies. This page discusses what to do with pilonidal disease with minimal symptoms, and you may find it helpful in deciding how to proceed.