Pilonidal Disease and Hidradenitis Suppurativa

Anuradha R. Bhama, Bradley R. Davis

Key Concepts

  • Pilonidal disease is an acquired chronic, infectious disease typically of the natal cleft with an unknown etiology, thought to be due to a combination of environmental and patient-specific factors.
  • The treatment for pilonidal disease should not result in worsening of quality of life than the disease itself. Incision and drainage for acute infections is mandatory, but further surgical treatment should be individualized.
  • Several operative strategies exist for the treatment of pilonidal disease; surgeons should be familiar with the various options available, though no single option has proven superior.
  • Wound care following pilonidal excision can have a major impact on quality of life and several nonoperative treatment strategies exist.
  • Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty. The primary clinical presentation is painful inflamed nodules in the apocrine gland-bearing regions that progress to abscesses, sinus tracts, and scarring.
  • The overall disease burden is disproportionate to the estimated prevalence, and patients with HS not seen and evaluated by dermatologists and surgeons may not get timely and appropriate treatment.
  • Therapy is initially medical and consists of antibiotics both orally and topically as well as immune modulators to manage the chronic inflammation.
  • Surgery is an important treatment for both acute abscess formation and painful scarring and deformity. Excision with primary closure and skin grafting can result in cure for patients with recalcitrant disease.

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Last updated: January 26, 2022