How is pilonidal disease diagnosed?
Pilonidal disease is diagnosed by your health professional after visually examining the area around the crease in the buttocks. The diagnosis of a pilonidal sinus can be made by identifying the epithelialized follicle opening, which can be
palpated as an area of deep induration beneath the skin in the sacral region. These tracts most commonly run in the cephalad direction. When the tract runs in the caudal direction, perianal sepsis may be present. The distinctions among pilonidal disease, fistula-in-ano, and hidradenitis can be difficult to discern. In the differential diagnosis, also include skin furuncle, syphilitic granuloma, tubercular granuloma, and osteomyelitis of the underlying sacrum with a draining sinus.
Recurrent pilonidal disease is observed most commonly after the incision and drainage of a pilonidal abscess. In this setting, the pilonidal sinus has not been excised and is still present after the abscess cavity heals, only to precipitate a recurrence. After surgical excision, the hair follicle has been removed and is no longer the pathogenic precipitating cause of the chronic pilonidal sinus. Instead, the base of the unhealed surgical wound is believed to become filled with granulation tissue, hair, and skin debris, which is a nidus for the ongoing foreign body reaction that takes place to create the chronic disease. This theory, coupled with the known predisposing intergluteal anatomy that draws hair into the pilonidal sinus cavity or surgical wound, is thought to precipitate the extensive recurrent and chronic disease. |
