What Is Pilonidal Disease? Symptoms,
Causes & Risk Factors
Pilonidal pits along the natal cleft
How does the disease arise?
The accepted theory is that inflammation of the hair roots and oil-secreting glands in the skin, at the bottom of the buttocks, causes their destruction and the formation of the pockets that underlie the pilonidal phenomenon.
Loose hair from all parts of the body gets trapped in the gluteal fold, penetrates through the openings created in the skin, and accumulates within the subcutaneous spaces. Hair in the gluteal fold itself can grow into fresh surgical wounds and prevent them from healing.
The infection that forms in the pilonidal sacs sometimes spreads to the buttocks on the sides, to the lower back, and sometimes to the anal area, forming exudative exit wounds in these places, with subcutaneous channels (fistulas) that connect the wounds on the periphery to the central inflammatory process in the gluteal fossa.
What is the disease?
The phenomenon was first described and given its name in the 19th century. The name "pilonidal" comes from the Latin language and means "nesting hair."
This is an acquired disease (not present at birth), usually occurring in the gluteal region (also possible in the navel and rarely in other locations). During this process, inflamed pockets form under the skin, with small openings in the skin, along the gluteal region.
The pockets usually contain free hairs.
Development of a pilonidal unit:
1.Normal pilosebaceous unit. 2. infected unit (folliculitis). 3. pit and subcutaneous cavity formation
Pilonidal abscess
Who is at risk and what are the symptoms?
Pilonidal sinus is most common in young people between the ages of 15-25, but can also occur in younger or older people.
The phenomenon is more common in males (about 4 times more common) and can manifest as local pain, skin bumps with discharge and a bad odor, and discomfort when sitting, which continue intermittently for years. Common complaints of those suffering from the disease are "pain in the tailbone", "pain when sitting in the tailbone", "inverted hair", "inverted hair on the tailbone", etc. Pilonidal disease is indeed common in the buttocks and above the "tailbone" area, but it is an inflammatory disease of the skin and below it and is not related to the bone at all.
Occasionally, an acute purulent inflammation (abscess) develops at the site, which is accompanied by swelling and severe pain and requires urgent surgical drainage.
Possible causes of the development of pilonidal disorder
1. Inflammation of the sebaceous glands in the skin that is common during adolescence and young people and is related to changes in hormonal activity that occur at these ages.
2. Genetic-familial predisposition (also linked to severe acne and recurrent infections in other skin folds).
3. Overweight — deep, moist buttocks with poor ventilation.
4. Smoking.
5. Prolonged sitting (driving professions), friction and repeated local trauma. During World War II, the phenomenon was called "Jeep Passenger Disease."
6. Inadequate personal hygiene habits.
7. Tight clothing.
8. Previous surgery or treatment — increases the risk of recurrence of the disease.
9. Excess body hair, mainly dark/black.
10. Usually a combination of several factors.