Pilondial disease (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • Highland HSCP
  • Primary Care
  • Adults

Pilonidal disease is, in essence, a skin condition in which hairs or a nest of hairs becomes a nidus for subcutaneous inflammation resulting in cysts, sinuses or even a complex network of subcutaneous tracts typically in the midline of the gluteal cleft.

Primary care management

Two key objectives: 

  1. Keep the gluteal fold free of hair that might cause a chronic inflammatory state; keeping the tracts open.
    • While there is currently insufficient evidence to make this a general recommendation, multiple laser epilations may result in reduced recurrence of disease. There are several laser clinics in the Highland area offering this service.
    • Advise patients that shaving has been associated with disease recurrence.
  2. Triage the patient into one of 4 groups as shown in the flow chart.
    • Asymptomatic: 
      • The patient has the characteristic pits in the gluteal cleft but no discharge or acute inflammation.
      • No treatment required at this point.
    • Symptomatic (chronic discharge) but no acute inflammation:
      • Can be routinely referred to general surgery for elective surgical excision of the affected area.
    • Symptomatic (acute inflammation): patient reports pain and redness and swelling, and on examination is tender on palpation, erythema and induration, ie, cellulitis.
    • Symptomatic (acute inflammation + abscess development):
      • Same day referral to General surgery for incision and drainage.

References

  1. ASCRS- Johnson EK, Vogel JD, Cowan ML, Feingold DL, Steele SR; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum. 2019 Feb;62(2):146-157. doi: 10.1097/DCR.0000000000001237. PMID: 30640830.
  2. ACPGBI- https://cks.nice.org.uk/topics/pilonidal-sinus-disease/management/asymptomatic-pilonidal-sinus-disease/

Editorial Information

Last reviewed: 19/06/2023

Next review date: 30/06/2026

Author(s): Colorectal department.

Version: 1.2

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Colin Richards, Consultant Colorectal Surgeon.

Document Id: TAM572