Management of Pilonidal Disease

Pilonidal disease (PD) is a benign condition affecting the natal cleft in young men and women usually between the ages of 20 and 40 years, ⁽¹⁾. Although there are conflicting etiological theories, the current consensus holds that pilonidal disease is an acquired condition intimately related to the presence of hair in the gluteal cleft. Loose hairs trapped in the natal cleft traumatize and penetrate the skin, creating a foreign body reaction that may ultimately lead to formation of midline pits and, in some cases, secondary infection, ⁽²⁾. The spectrum of pilonidal disease presentation varies from a chronic cyst and/or sinus with persistent drainage and/ or extensive subcutaneous tracts to the more acute presentation of an associated abscess, ⁽³⁾. Numerous treatment options are available that include gluteal cleft hair removal, tract ablation, simple excision, and wide excision with flap reconstruction, ^{(4 & 5)}.

This clinical practice guideline will focus on the evaluation and management of pilonidal disease.