Evaluation and management of pilonidal disease.

The history of pilonidal disease dates back to the early 1800s, and it continues to be a significant health issue today. Herbert Mayo was the first to describe a disease that involved a hair-filled cyst at the base of the coccyx in 1833. In 1880, Hodge coined the name ‘‘pilonidal’’ from the Latin pilus that means hair and nidus that means nest. During World War II, over 80,000 soldiers in the United States Army were hospitalized with the condition. It was termed ‘‘Jeep riders’ disease’’ because a large number of soldiers who were being hospitalized for pilonidal disease rode in jeeps and long journeys on rough terrain were felt to cause the condition because of pressure on and irritation of the coccyx. Currently, pilonidal disease is a fairly common condition that affects many patients worldwide. In the United States alone, nearly 70,000 patients are diagnosed with this potentially morbid condition each year. The disease itself and many of its treatments often result in time lost from work or school, and it burdens patients and caregivers with wound care and frequent trips to the office or hospital. Initially thought to be congenital in origin, pilonidal disease is now thought to be an acquired condition related to the presence of hair in the natal cleft. This loose hair causes a foreign body reaction that leads to midline pit formation (Fig. 1). Pilonidal disease can present as a simple cyst, an acute abscess with or without cellulitis, or a chronic draining sinus. Treatment, therefore, is also highly variable and can include observation and hair removal, incision and drainage, or excision with sometimes complex surgical reconstruction. Diagnosis begins with a focused history and physical examination to include symptoms, risk factors, and presence of active infection. Patients may present with complaints of a tender, fluctuant sacrococcygeal mass in the case of secondary infection or may report midline drainage and discomfort in the case of a chronic sinus. On