What Causes Pilonidal Disease?
There have been many theories regarding what causes pilonidal cysts, sinuses, and wounds to develop. Long ago, it was believed that it was a congenital problem; in other words that a person was born with a pilonidal cyst, that became symptomatic at some point later in life (usually teens or 20’s).
However, we now believed in the “acquired” theory rather than the “congenital” theory. Pilonidal disease is something that develops as individuals start developing their adult body shape. In our clinic we have seen patients as young as ten years old with this problem, but these particular patients are almost adult size and shape in spite of their young age.
Is this just an ingrown hair?
No. Although there are hairs involved this this disease, “ingrown” hairs are not the cause. An ingrown hair is a hair that is still connected to the skin by it’s follicle, and is growing such that the tip of the hair is penetrating the skin, and as the hair grows these hairs bury themselves deep into the dermis.
The hairs involved with pilonidal disease are loose hairs that have been broken or cut. They can come from anywhere in the body, but researchers have found that they come predominantly from the head, not from the torso.
So, What Causes It?
The exact cause is not 100% clear, but there are certain factors that are believed to contribute to the development of pilonidal disease in one person, and not in another:
- A deep gluteal cleft
- Fragile skin in the midline of the gluteal crease
- Stiff, sharp hairs
Who gets pilonidal disease?
Anyone can develop this problem, but as mentioned above it is usually someone with a deep gluteal crease. This problem is NOT caused by:
- being very hairy
- being overweight
- poor personal hygeine
- excessive sitting
- trauma to the area
What are the signs of pilonidal disease?
One of the first physical findings in a patient who is developing pilonidal disease are enlarged pores, also called “pits”, that appear in the midline of the gluteal crease. Hairs find their way into these tiny pits, and because hairs are not smooth, but instead are serrated, if a hair enters these pores root-end first, it will not easily come out, and will be drawn farther into the small hole. This ultimately creates a pocket of hairs in the subcutaneous tissue, which we call a “pilonidal cyst”.
This pocket of hairs can manifest itself with just a small tender bump, can become infected, can tunnel off to the side and drain, or the pit can become enlarged to the point that one could call it a “wound”.
What strategies are helpful in treating pilonidal disease?
Because we know that the depth of the gluteal crease and the fragile midline skin play a role in the development of pilonidal cysts, this can guide treatment. The optimum treatment is an operation that flattens the gluteal crease, removes the midline skin, and brings the incision away from the center line, which is exactly what a properly performed cleft lift will accomplish. Of course, acute infections (abscesses) should be drained.
If surgery is not an option, there are some home remedies that may be helpful in the short term.
What is the best treatment for pilonidal disease?
In our clinic we only perform the cleft lift because it is the procedure with the highest success rate. It has a dramatically easier recovery than an open excision, and because we do this every day, our infection rate is low and recurrence rate low.
There are certainly other operations that can be tried, but none have as low a recurrence rate as a cleft lift performed by an expert.
