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Localized alteration usually in the region between the buttocks, next to the coccyx, which can cause pain, inflammation or discharge. The treatment is adapted to the presentation and evolution of the disease.
A small hole or opening at the top of the buttocks?It may be a pilonidal disease - also known as a pilonidal cyst.Common especially in adolescence. It is treatable and should not be a cause for embarrassment.
Loose hairs can penetrate the skin of the crease and trigger inflammation. It is not a congenital cyst.
01
Friction and pressure favor the entry of loose hairs into the skin.
02
The body reacts and small openings or pathways may appear under the skin.
03
The cavity can cause pain, drain fluid or become an abscess.
LATERAL CUT
The cavity is between the skin and the deep planes. A small hair may be visible on the surface.
SKIN
CAVITY + HAIR
BONE
IMPORTANT
It is not contagious and does not mean a lack of hygiene. The anatomy of the crease, hairs, friction and pressure also contribute.
The examination distinguishes a small opening without inflammation from symptomatic disease or an abscess.
NO SYMPTOMS
Usually monitor, care for the area and control the hairs - do not operate preventively.
SYMPTOMATIC DISEASE
There may be redness, pus or blood, sometimes with odor. It should be evaluated in a consultation.
POSSIBLE ABSCES
It can increase rapidly and cause fever. It needs quick observation and, usually, drainage.
The diagnosis is usually clinical. Imaging tests are not necessary in most cases.
Laser hair removal reduces the hairs in a lasting way and decreases the likelihood of new hairs penetrating the skin.
WHEN THERE IS NO ACUTE INFECTION
Integrate laser and local care into the plan from the initial evaluation.
Observe symptoms, drainage and response before deciding on elective surgery.
Continue to control the hairs after healing, as directed.
In selected cases without an abscess, local care and laser hair removal can control the disease and avoid surgery.
When clinically possible, it can start before elective treatment and continue after healing.
PAINFUL ABSCES?
Drainage has priority. Hair removal should not delay acute phase treatment.
It may be recommended in case of persistent pain or drainage, repeated episodes, non-healing wound or extensive disease.
The disease is removed and the wound heals progressively, with regular dressings.
≈ 30–60 min
The wound is closed in the same procedure, when the extension and anatomy allow it.
The reconstruction displaces the closure of the crease; useful in extensive or recurrent disease.
≈ 60–90 min
WHAT TO EXPECT
ANESTHESIA
Usually general
DISCHARGE
Usually on the same day
SCHOOL
Frequently 1–2 weeks
HEALING
Closed wound: usually 2–4 weeks · Open wound: frequently 6–12 weeks
Sports, bicycle and swimming: only resume with the team's indication.
Approximate times: vary with extension, technique, wound evolution and comfort when sitting. The total time in the clinic is superior to that of surgery.
Surgery treats what has already formed; lasting control of the hairs reduces one of the main mechanisms that can make it come back.
Maintain the indicated laser hair removal program to reduce the entry of new hairs into the crease.
Follow the dressings and keep the area clean and dry according to clinical guidance.
Monitor until complete healing and report new symptoms early.
SEEK EVALUATION QUICKLY IF
Do not squeeze, pierce or try to drain at home.
Did you notice an opening, a lump or repeated discharge?
Book a Pediatric Surgery consultation
If the patient has recurrent infections or other clinical conditions that may justify surgery.
The doctor will evaluate the patient's level of comfort, taking into account their hygiene and potential complications.
The doctor will discuss the expectations and benefits of the procedure.
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