In pilonidal disease, a lesion called a coccygeal or pilonidal cyst develops in the sacral area. The cystwhich usually contains hair - becomes infected and commonly produces an abscess, a draining sinus, or a fistula. Generally, a pilonidal cyst produces no symptoms until it becomes infected. The incidence is highest among hirsute, white men ages 18 to 30.
The exact reason why pilonidal disease occurs is still unclear. Possible causes include:
Signs and Symptoms
Investigation of the patient's history may turn up one or more predisposing factors for pilonidal disease. Typically, the patient complains of localized pain, tenderness, swelling, and heat over the affected area. He may also describe continuous or intermittent purulent drainage. If the infection is severe enough, signs and symptoms include chills, fever, headache, and malaise.
On inspection, you may detect a series of openings along the midline, with thin, brown, foul-smelling drainage or a protruding tuft of hair. Palpation of the area may produce purulent drainage, if the drainage isn't already continuous.
Cultures of discharge from the infected cyst may show Staphylococci or skin bacteria; the discharge doesn't usually contain bowel bacteria.
Conservative measures consist of incision and drainage of abscesses, regular extraction of protruding hairs, and sitz baths (four to six times per day). However, persistent infections may result in abscess formation and require surgical excision of the infected area.
After excision of a pilonidal abscess, the patient requires regular follow-up care to monitor wound healing. The surgeon may periodically palpate the wound during healing with a cotton-tipped applicator, curette excess granulation tissue, and extract loose hairs to promote wound healing from the inside out and to prevent dead cells from collecting in the wound. Complete healing can take several months.
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