Evaluation and Management of Pilonidal Disease
Section snippets
Etiology and diagnosis
The history of pilonidal disease dates back to the early 1800s, and it continues to be a significant health issue today. Herbert Mayo was the first to describe a disease that involved a hair-filled cyst at the base of the coccyx in 1833.1 In 1880, Hodge coined the name “pilonidal” from the Latin pilus that means hair and nidus that means nest.2 During World War II, over 80,000 soldiers in the United States Army were hospitalized with the condition. It was termed “Jeep riders' disease” because a
Nonoperative Management and Adjuncts to Operative Strategy
Because the cause of pilonidal sinus disease is widely attributed to hair follicle ingrowth and subsequent foreign body reaction, local hair control, whether by shaving or laser epilation, has been used as a primary treatment and as an adjunctive strategy.5, 6, 8, 10, 11, 12, 13, 14 Compared with various surgical techniques, shaving and improved hygiene have been demonstrated to decrease total hospital admission days and surgical procedures and has resulted in faster return to work or school.15
Management options: recurrent pilonidal disease
Recurrence rates for pilonidal disease vary widely and have been reported to be as high as 50% following primary intervention, and as high as 10% to 30% after subsequent interventions.10 These rates indicate that many patients will continue to have treatment failure despite the type of management chosen. The cause of these failures is not completely known, although wound complications at primary intervention were shown to be predictive.
Management of recurrent disease is similar to that of
Carcinoma in pilonidal sinus
Carcinoma arising from a pilonidal sinus is rare, occurring in approximately 0.1% of patients with chronic untreated or recurrent pilonidal disease. It is believed that the process involves the release of oxygen free-radicals by activated inflammatory cells, similar to carcinoma arising in other ulcerating and chronically inflamed disorders. The first case was reported by Wolff in 1900, and less than 100 cases have been reported in the literature since that time. The cell-type is usually
Summary
Pilonidal disease is a fairly common condition that is associated with significant morbidity. It exists in many forms: asymptomatic, acutely infected with associated cellulitis and abscess, and chronic in nature, presenting a management dilemma because of its location. There are a multitude of described interventions, surgical and nonsurgical, and, thus far, no treatment modality has proven to be superior. The general principles of therapy include good hygiene practices, hair control, and
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