Pilonidal Disease Management: Guidelines from the ASCRS
Am Fam Physician. 2019 Nov 1;100(9):582-583.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Pilonidal disease without abscess is best managed by frequent shaving or hair removal; adding local application of phenol can resolve disease and prevent recurrence.
• Fibrin glue application can be used alone or with surgical excision to treat chronic pilonidal disease without abscess and reduce recurrence
• Abscesses should be treated with incision and drainage or surgical excision.
From the AFP Editors
Pilonidal disease is a reaction to hair in the gluteal cleft, in which unattached hairs injure or pierce the skin, resulting in a foreign body reaction. The condition, which has an annual incidence of about 70,000, can lead to midline pits or secondary infection. Signs and symptoms include cysts or sinus with drainage, subcutaneous tracts, or abscesses. The American Society of Colon and Rectal Surgeons (ASCRS) has released a clinical practice guideline to provide physicians with diagnosis and treatment options.
The differential diagnosis includes hidradenitis suppurativa, infected skin furuncles, Crohn disease, and perianal fistula. Most patients with pilonidal disease will present with midline pits in the gluteal cleft, although they also may have surrounding cellulitis or abscess. Patients with chronic disease will most often present with chronic draining sinus disease in the intergluteal fold. The physical examination for suspected pilonidal disease should involve an anal examination to rule out fistula.
In patients with confirmed pilonidal disease without an abscess, hair removal from the gluteal cleft via shaving or laser epilation is a key treatment. The optimal frequency of shaving is unclear, but the ASCRS recommends at least weekly. It should be noted that a local anesthetic and more than one treatment session may be needed when opting for laser epilation.
Local application of phenol also is an effective treatment option; it has been shown to resolve the condition in at least 67% of patients and prevent recurrences
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, editor-in-chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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