Pilonidal Disease: Definition, Acute Management, and Associated Risks

Definition and Pathophysiology

Pilonidal disease is a chronic condition of the sacrococcygeal region that may appear as a cystic lesion or, when infected, as an acute abscess. 1
The chronic form is characterized by peripheral inflammatory nodules and interconnected drainage tracts that eventually lead to scarring. 3

Complex pilonidal abscesses require surgical drainage combined with broad‑spectrum systemic antibiotics that cover Gram‑positive, Gram‑negative, and anaerobic organisms. 5

Systemic antibiotics are indicated when patients exhibit systemic inflammatory response syndrome (SIRS) criteria (e.g., temperature > 38 °C or < 36 °C, respiratory rate > 24/min, heart rate > 90/min, white‑blood‑cell count > 12,000 or < 4,000 µL). 1
Systemic antibiotics are indicated for immunocompromised patients. 5
Systemic antibiotics are indicated when source control is incomplete (e.g., residual cavity after drainage). 5
Systemic antibiotics are indicated in the presence of extensive associated cellulitis. 5

Pilonidal disease co‑exists with hidradenitis suppurativa in 1.4 %–2.3 % of patients, compared with 0.1 %–0.3 % in control populations. 3
Individuals with hidradenitis suppurativa have a 4.97‑ to 5.61‑fold increased risk of developing pilonidal disease. 3

A recurrent abscess at the same site should prompt investigation for an underlying pilonidal cyst, hidradenitis suppurativa, or retained foreign material. 1
Marsupialization of chronic pilonidal disease is associated with a low recurrence rate of approximately 4 %. 2