Pilonidal Disease and Hidradenitis Suppurativa

Abstract

``Pilonidal disease'' refers to a subcutaneous infection occurring in the upper half of the gluteal cleft. It may present as an acute ``pilonidal abscess,'' or as an indolent wound, resistant to spontaneous healing, and causing drainage and discomfort. It typically presents in the second decade of life, but also occurs in teenagers and in patients in their thirties.1 It afflicts men more often than women at a ratio of three or four to one, and is more common in individuals with more body hair.1 It is not known to be more common in any one racial group. During World War II, soldiers filled up whole hospital wards to convalesce from the large excisional operations used at the time to treat pilonidal disease.2 It became such a problem that the Surgeon General forbade wide local excision as primary therapy, because this treatment had hospitalized 79,000 soldiers for an average hospital stay of 55 days.3 Akinci et al.4 reported an 8.8{%} incidence of pilonidal disease in Turkish Army recruits and found associations with family history, obesity, being a vehicle driver, and having a history of a furuncle at another site on the body. Sondenaa et al. studied 322 patients with pilonidal disease prospectively and calculated the incidence of the disease at 26 per 100,000 persons. It occurred 2.2 times more often in men than in women. He also found the following significant associations: family history in 38{%}; obesity in 37{%}; preceding local irritation or trauma in 34{%}; and a sedentary occupation in 44{%}. Since World War II, a paradigm shift has occurred in favor of conservative measures, mainly in the form of shaving and hygiene.