Pilonidal disease: A new look at an old disease

Pilonidal disease is a very common affliction that affects mainly young, hirsute, obese males during their young adult years of life. Previous etiological theories of this ailment centred on congenital causes. The current understanding is that pilonidal disease is an acquired affliction. Some patients, however, may have confounding hereditary tendencies to form pilonidal disease. There is a myriad of methods of treatment for chronic pilonidal disease. Such treatments vary from the creation of large skin flaps to simple instillation of chemicals into the sinuses. No single technique is favoured by every surgeon and each technique has its ardent supporters. The current favoured treatments however, are toward the use of the less invasive options compared to the large extensive flaps. Favoured options include minimally invasive techniques as well as simple lay open and marsupialisation. No proposed classification system for the assessment of severity of pilonidal disease has correlated disease severity with treatment options. Therefore, no classification system is in widespread use by the surgical community. Post-operative supportive management, especially in the early post-operative period, and laser hair epilation after the initial healing phase, have some usefulness in the overall treatment of pilonidal disease.