Pilonidal disease, commonly known as “ingrown hair,” is medically termed a pilonidal sinus. It is a hair-containing cyst that forms when hairs penetrate beneath the skin. Although most frequently seen in the sacrococcygeal (tailbone) region, it may also occur in the navel, face, groin, or armpit. It is most common between the ages of 15 and 35. In Türkiye, it affects approximately 10% of young men. It is three times more common in men, though its incidence in women has been rising in recent years. After age 45, it becomes less frequent.
Why Does It Occur?
Although previously thought to be congenital, it is now accepted as an acquired condition. Three major factors predispose to the formation of a pilonidal sinus: the presence of hair in the area, skin sensitivity, and sufficient trauma or pressure to push hair inward. Through friction, hairs can penetrate beneath the skin via sweat gland openings, causing obstruction and edema. When bacteria join this foreign-body reaction, an abscess may form or rupture, creating sinus tracts.
A deep intergluteal cleft, being a hairy young adult, obesity, prolonged sitting due to occupational reasons, friction and pressure, inadequate personal hygiene, excessive sweating, and folliculitis in other body regions all increase the risk of pilonidal disease in the sacrococcygeal area.
What Symptoms Does It Cause?
Patients may present with small swellings in the tailbone area, itching, hair-containing or hairless pits, and foul-smelling or odorless bloody discharge from these openings. Some patients experience severe pain and redness due to a pilonidal abscess. After drainage of the abscess, surgery is recommended to prevent recurrence.
How Is It Diagnosed and Treated?
Diagnosis is generally made based on medical history and physical examination. Surgical treatment remains the most effective method.
Various surgical techniques have been described, including open healing, primary closure, and flap procedures. Minimally invasive surgical methods have become increasingly popular due to short hospital stays (usually one day), rapid return to normal activities and work, low complication rates, and outcomes comparable to other approaches. PRP therapy, widely used in many medical fields to accelerate tissue regeneration, is also successfully applied in pilonidal disease to support faster wound healing.
After surgery, patients are advised to maintain good personal hygiene of the area. Shaving is not recommended because it increases the risk of recurrence. Laser hair removal performed in several sessions after surgery has been reported to be effective.
