Reviewed on : 16 Dec 2019

Reviewed by : Phil Baragwanath Consultant Colorectal Surgeon UHCW

Expires : 16 Dec 2021

Pilonidal sinus

Pilonidal sinus can range from:

• Asymptomatic pits
• Acute abscesses
• Extensive chronic abscesses
• Sinus tracks

Often occurs in young active people.

Acute abscesses should to be referred to the On Call Surgical Team using the SAU Abscess Pathway.

Pilonidal sinus disease seems to be associated with smoking, obesity and poor hygiene.

Conservative management

Asymptomatic midline pits should be managed conservatively.

Advise showering or bathing the natal cleft more than twice a week (to remove loose hairs and reduce the risk of infection).

Advise obese patients to lose weight and smokers to quit.

Hirsute patients may benefit from keeping the natal cleft hair-free.

Shaving might increase the risk of folliculitis and alternatives include waxing and use of depilatories.

The best evidence is for laser depilation although trials looked at prevention of recurrence after surgical treatment.

Pilonidal sinus rarely starts after 40years of age and even active disease settles down in later life.

Surgical management

Acute abscess can sometimes be prevented from developing by a course of antibiotics.

Once abscess cavities and fistulating disease has commenced it rarely settles with conservative treatment.

Acute abscesses require simple incision and drainage (with curettage of hair debris).

40-60% will heal up and require no further treatment.

For those with continuing symptoms refer to colorectal

Healing rates should be in the region of 90%.

NICE Guidance Pilonidal Sinus

Pilonidal Sinus scenario

Pilonidal Sinus scenario 1

Pilonidal Sinus scenario 2